Diabetes

Last update 01.07.24

Diabetes - Medical Information and Overview

Introduction

What is diabetes?

Diabetes is characterized by high blood sugar levels and metabolic abnormalities. Over time, elevated blood sugar levels damage vital organs and impair their ability to function.
The persistent presence of excess glucose (sugar) in the blood is known as hyperglycemia.

Types of Diabetes

Diabetes primarily occurs as type 1 or type 2. Although the causes of each disease differ, both types are characterized by elevated blood glucose levels.

Type 1 Diabetes

Type 1 diabetes is caused by a defect that prevents the pancreas from producing insulin, a hormone that plays a crucial role in regulating blood glucose levels. In the past, it was referred to as 'insulin-dependent diabetes' or 'juvenile diabetes' because it typically develops at a relatively young age.

For medical information on type 1 diabetes

Type 2 Diabetes

In type 2 diabetes, the body is unable to effectively utilize the insulin it produces. The combination of insulin resistance and reduced insulin production results in elevated blood glucose levels. Over 90% of diabetics are diagnosed with type 2 diabetes. Despite its prevalence, individuals may be unaware they have the disease. This is because the disease develops gradually, and its symptoms are less apparent compared to those of type 1 diabetes. Type 2 diabetes is more common in older individuals.

Untreated diabetes can lead to late complications, potentially affecting the blood vessels, eyes, kidneys, nervous system, and heart. Over time, deviations from normal blood glucose levels can result in cumulative damage. Therefore, it's important to manage blood sugar levels primarily through lifestyle changes, including regular physical activity, proper nutrition, medication, and beneficial health behaviors.

For medical information on type 2 diabetes

How do blood sugar imbalances and monitoring influence blood sugar levels?

Diabetes is a condition in which the body struggles to maintain normal blood sugar levels, leading to either hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar).

What are normal blood sugar levels?

Sugar levels are typically determined by three indicators:

  • Fasting blood sugar levels: measured after not eating or drinking (except water) for at least 8 hours.
  • Postprandial blood sugar levels: measured about two hours after a meal, without consuming anything else in between.
  • Glycated hemoglobin (HbA1c) levels: 's average blood sugar levels over the past 3 months.

Diabetes typically contributes to higher values of all three indicators.

Normal ranges for a person without diabetes:

70-100 mg/dl

Fasting blood sugar levels

Up to 140 mg/dl

Two hours after eating

Up to 5.7%

Glycated hemoglobin

70-100 mg/dl

Up to 140 mg/dl

Fasting blood sugar levels

Two hours after eating

70-100 mg/dl

Up to 5.7%

Fasting blood sugar levels

Glycated hemoglobin

Ranges in diabetics:

80-130 mg/dl

Fasting blood sugar levels

140-180 mg/dl

Two hours after eating

6.5-8%, or more

Glycated hemoglobin

80-130 mg/dl

140-180 mg/dl

Fasting blood sugar levels

Two hours after eating

80-130 mg/dl

6.5-8%, or more

Fasting blood sugar levels

Glycated hemoglobin

How are blood sugar levels affected?

  • Many factors influence blood sugar levels. A healthy lifestyle, comprising proper nutrition, regular physical activity, and stress management, greatly influences blood sugar levels. Typically, lifestyle changes and proper medications will lead to changes in blood sugar levels, based on the extent of these changes.

Treating blood sugar imbalances

  • Blood sugar imbalances take two forms - hypoglycemia and hyperglycemia:

Hypoglycemia

  • When blood sugar levels drop below 70 mg/dL, potentially impairing functioning. Hypoglycemia can also occur in diabetic individuals with consistently high blood sugar levels. Some diabetic patients do not sense hypoglycemic episodes. It's important to treat hypoglycemia, as it can worsen and may even lead to loss of consciousness.

Signs of hypoglycemia (low blood sugar)

  • Cold sweat
  • Blurred vision and dizziness
  • Hunger
  • Weakness
  • Heart palpitations
  • Increased tremors
  • Nervousness
  • Confusion and balance problems
  • Slurred speech

Causes of hypoglycemia

  • Sudden increase in physical exertion
  • Reducing food intake or skipping meals
  • Consuming alcohol on an empty stomach
  • Excessively high insulin or medication dose

Treating hypoglycemia

Quickly boosting sugar intake must take priority.

  • Drink half a glass of sweetened beverage (not diet), consume three sugar cubes or teaspoons of sugar, or take sugar pills/drinks designated for diabetics (available over-the-counter at pharmacies).
  • Individuals treated with insulin should have a glucagon preparation on hand. It's crucial that a family member receive instructions from a nurse and learn how to administer the preparation to the diabetic patient if necessary.
  • After raising sugar levels, have a meal containing complex carbohydrates along with protein or fat, such as a sandwich with cheese or tahini, to prevent the prompt recurrence of hypoglycemia. Monitor blood sugar levels and consult with medical professionals regarding further treatment.

Hyperglycemia

When blood sugar levels are too high - over 250 mg/dL when fasting, accompanied by the following symptoms:Adhering to prescribed medications and maintaining a healthy lifestyle help prevent these conditions.

Treating hyperglycemia

Causes of hyperglycemia

Signs of hyperglycemia

Physical activity can help mitigate mild hyperglycemia

Consuming excessive carbohydrates beyond the recommended intake

Thirst

If your blood sugar exceeds 400 mg/dL, consult a Maccabi Nonstop nurse immediately !

Failure to adhere to prescribed medication dosages

Dry mouth

Fever or inflammation

Excessive urination

Stress-inducing situations

Weakness and fatigue

Treating hyperglycemia

Physical activity can help mitigate mild hyperglycemia

Causes of hyperglycemia

Consuming excessive carbohydrates beyond the recommended intake

Signs of hyperglycemia

Thirst

Treating hyperglycemia

If your blood sugar exceeds 400 mg/dL, consult a Maccabi Nonstop nurse immediately !

Causes of hyperglycemia

Failure to adhere to prescribed medication dosages

Signs of hyperglycemia

Dry mouth

Treating hyperglycemia

Causes of hyperglycemia

Fever or inflammation

Signs of hyperglycemia

Excessive urination

Treating hyperglycemia

Causes of hyperglycemia

Stress-inducing situations

Signs of hyperglycemia

Weakness and fatigue

What is self-monitoring of blood glucose?

Blood sugar levels change rapidly. It's crucial to independently measure them multiple times a day using a home glucometer, enabling you to identify imbalances and adjust treatment accordingly.

Advantages of self-monitoring

  • Accessible, reliable, and rapid testing
  • Greater self-awareness of changes and symptoms
  • Facilitates advance planning and helps prevent irregularities
  • Enables optimal disease management and control

Goals of self-monitoring

Recognizing fluctuations in blood sugar levels throughout the day

  • For treatment adjustment: beginning new regimens and altering medication dosage.
  • Detecting and treating hyperglycemia.
  • Detecting, preventing, and treating hypoglycemia (blood sugar levels dropping below 70 mg/dL).
  • Identifying and planning for various events affecting sugar levels, such as parties, illness, physical activity, and more.
  • Offering immediate data on how different foods affect sugar levels.

Self-monitoring guidelines

  • Measurements must adhere to the manufacturer's instructions
  • Update the device’s date and time settings
  • Make sure the testing strips are not damaged or expired
  • Wash your hands before every test
  • Prick your fingertip with the lancet
  • Squeeze a drop of blood onto the testing strip
  • Record and report as per medical recommendations
  • Check and calibrate the device

Diabetic patients who regularly self-monitor blood sugar levels are healthier and significantly reduce their odds of complications.

Insulin

Living with insulin

What is insulin?

Insulin is produced in the pancreas' beta cells and secreted into the bloodstream. Today, genetically engineered insulin can be administered via subcutaneous injection.
Insulin lowers blood sugar in two main ways:

  • By helping blood glucose (sugar) enter cells and be used as energy.energy
  • By encouraging glycogen generation, a sugar stored in the liver.

There are two main types of diabetes:

Type 1 diabetes: occurs when beta cells are destroyed, halting insulin production and necessitating insulin injections. This is the most common type in young patients.
Type 2 diabetes: occurs when insulin cannot be effectively utilized. This type of diabetes is more common, accounting for about 90% of all adult diabetics and requiring lifestyle changes, oral medication, and insulin injections.

When should insulin treatment begin?

For type 1 diabetes - upon diagnosis.

For type 2 diabetes - in the following cases:

  • Severe hyperglycemia - when sugar levels are significantly above normal.
  • Uncontrolled diabetes despite long-term use of oral medication.
  • When oral medication is contraindicated (kidney or liver disease).
  • When diabetes develops during pregnancy and cannot be managed through diet.

Insulin side effects

Hypoglycemia, low blood sugar level (less than 70 mg/dL) - it's important to treat this condition, as the imbalance can worsen and may even lead to loss of consciousness. Inject insulin as per the doctor's instructions and maintain a healthy lifestyle to prevent hypoglycemia.

Insulin storage

  • Refrigerate insulin until the expiration date indicated on the bottle
  • If using immediately, store insulin at room temperature in a cool, shaded area.
  • Unrefrigerated insulin remains usable for up to 6 weeks

What types of insulin are available, and how should they be administered?

a. Long-acting basal insulin (Lantus, Levemir, and Degludec)
Inject at a fixed time daily, regardless of meals, and at a fixed dose regardless of current sugar levels.
b. Insulin mixture (Novomix/Humalogmix)

  • Inject within 10 minutes before or at the start of the meal.
  • It is important to measure sugar levels before each injection.
  • Maintain consistent and scheduled injection times.
    It is recommended to adjust doses based on pre-meal sugar levels and the meal's carbohydrate content.
    c. Short- and rapid-acting insulin (Apidra/Novorapid/Humalog)
    • Inject within 10 minutes before or at the start of the meal.
    • Insulin dosage adjustments will be made according to the prescribed treatment plan.
    • It is important to measure blood sugar levels before each injection.
    • It is recommended to adjust doses based on pre-meal glucose levels and the meal’s carbohydrate content.
    • Learning to count carbs is crucial.
    • To adjust short-acting insulin doses effectively, it's important to consult with a dietician to understand two key formulas: Insulin-carbohydrate ratio: This formula calculates the amount of carbohydrates in different foods and determines the corresponding insulin units needed per dose to maintain balanced blood sugar levels. Correction factor: how many insulin units decrease blood sugar levels until the target level is reached.