Diabetes Information for the Newly Diagnosed


Being diagnosed with Diabetes can be a traumatic experience, as most
of us who have diabetes know only too well. Initial reactions range
from denial, a common reaction, to panic. Understanding the nature of
the disease, the measures that you can take to help yourself, and the
medications available will all help your understanding of the
situation in which you now find yourself.

Diabetes is not a new disease; indeed, it has been known for many
thousands of years and was certainly known by the Pharaohs of ancient
Egypt. Before the advent of modern testing methods, diabetes could be
detected by tasting urine to see if it had a sweet taste. Another
method was to drop some urine near an ants' nest to see if the ants
were attracted by the sugar content.

There are two main Type of Diabetes Mellitus (DM): Insulin Dependent
(IDDM) and Non-Insulin Dependent Diabetes Mellitus (NIDDM). The News
and Newcomers library contains files that discuss these and other
matters in much greater detail than I do here.

Insulin Dependent Diabetes Mellitus (IDDM) may be known by a number of
descriptions, the most common being Juvenile Diabetes, because it
often - but not always - begins during childhood. Simply put, IDDM
(10% of diabetics) is caused by the auto-immune system attacking the
pancreas, where insulin is produced, and can only be managed by
injecting insulin. IDDM has been proven to have a genetic link. Many
people live long lives even though they have IDDM, but good
understanding of the nature of the disease and good self management
are the keys to surviving this life-threatening illness. The forum
libraries contain many hundreds of files dealing with almost all
aspects of IDDM. Recommended reading for those who have IDDM is
___________. [coming soon!]

The second main Type of DM, NIDDM, is usually known as Type 2 and is
sometimes referred to as adult onset because it often - but not always
- manifests itself later in life. This is by far the most common form
of diabetes, accounting for 90% of the cases. For the purposes of this
introduction I will refer to it as Type 2 DM. It should be noted,
however, that some Type 2's eventually become dependent upon insulin
injections as their systems begin to produce less insulin.

The onset of Type 2 DM may start many years, possibly as many as 10,
before any symptoms are observed. Like Type 1 IDDM, Type 2 DM also has
a genetic link although some people, myself being a case in point, can
find no close relations on either side of the family who were
diagnosed DM. Type 2 DM is a failure of the endocrine system. There
are 26 potential different etiologies of Type 2 dm, so there could be
up to 26 different forms of it, each with a totally different cause.
They all eventually result in the body being unable to make the best
use of the insulin being produced by the pancreas. This "resistance"
leads to the cells being unable to process properly the
carbohydrates/sugars that we eat. 

Angela Chiffy likens this resistance to insulin being a key and the
outside of the cell as a lock on a door.  The insulin is supposed to
fit into the lock, open the door and let the glucose in.  When the
cells are resistant to insulin, it's as if someone has jammed
something into the lock and the insulin can't release the lock. 

The unprocessed sugars that result get into the blood stream and are
filtered out by the kidneys. This results in the classic symptoms of
DM: the most common being passing excessive urine, as the system tries
to get rid of the excess sugars; excessive thirst for the fluids
needed to replace those passed from the system by the kidneys;
tiredness at times of the day when one would not expect to feel tired;
irritability; changes in vision; tingling or sore feet and/or fingers.
Another tell-tale sign that is often observed without being linked to
DM is a black ring that builds up in the WC (toilet) as a result of
growth of flora and fauna that are fed by the sugars that are in the
urine. Other common symptoms of DM are yeast infections (thrush),
dry/itchy skin that can easily crack in cold weather and, sometimes,
early signs of sexual dysfunction. However, remember that often there
are no symptoms until many years after diabetes has started.

These and many more aspects of Type 2 diabetes are discussed at length
in the file T2INFO.TXT (also available as T2INFO.ZIP) in library 2.
This file prints to over 70 pages and is essential reading for the
newly diagnosed.

The newly diagnosed diabetic must ensure that he has the best medical
support he can get. It can be the case that general practitioners know
all too little of DM and its current treatment and, therefore, it is
essential to get a referral to a diabetes specialist, usually an
endocrinologist. The two main factors in managing Type 2 DM are
diet and exercise. It is also essential to get a referral to a
dietician who specializes DM.

Diet and Exercise 

Diet and Exercise, together with drugs if the doctor(s) consider them
necessary, are the keys to bringing runaway blood sugar levels
(usually referred to as blood glucose or BG) under control. A typical
Type 2 diet regimen involves a low fat, well balanced "heart smart"
diet based upon eating smaller meals at more frequent intervals in the
day than is normally the case. This is commonly referred to as
grazing, and is aimed at providing a regular intake of essential foods
including carbohydrates to help to maintain more stable BG levels.
CAUTION: You will come across a great many "diets" which claim to be
the cure for all ills. Before embarking on any such diet, it is
essential to understand the effect of diet on DM and, if possible, to
get good professional advice. Section 7 (Diet and Exercise) of this
forum is devoted to dietary matters and many useful hints and tips as
well as recipes are available there.

Note: Did you doctor tell you to "avoid sugar" or "watch the sugar?"
If so, you may want to get a more up-to-date doctor.

Exercise is absolutely essential in the control of DM because it
promotes the body's ability to process the insulin and it helps
greatly with the blood circulation. People who have diabetes are at a
much higher risk of developing cardiovascular, neurological and other
problems. Exercise is often the key to getting off medication and to
being able to maintain a good control of the diabetes, as well as
promoting general good health. A basic beginning exercise regimen
would be five half-hour periods of brisk walking each week. For those
who are capable of doing more, there is no real limit to what can be
done, but stick to aerobic (not extreme strain, huff and puff)
activities. For those who have physical problems that restrict their
ability to exercise, any exercise is better than none.


Hypoglycemia/Hyperglycemia

Hypoglycemia is when the level of sugar in the blood falls below the
level at which our bodies function properly. For Type 1 IDDM this can
be extremely dangerous and can lead to serious accidents, shock and
death. If you are IDDM, it is essential that you learn about the
dangers of hypo's. Type 2's can also experience hypo's (sometimes
referred to as "lows") but, although very unpleasant, it rarely
results in serious short term danger, except if it occurs when
driving, operating machinery or during dangerous sports. It is
usually, but not always, the case that when experiencing a hypo the
liver responds by producing sugars. The best and quickest remedy for a
hypo is half a can of regular Coke/Pepsi or any other normally
sweetened drink followed by a snack containing carbohydrates. Because
our brains require sugar to function, shortage of sugar can make us
feel disorientated, shaky and is a very uncomfortable feeling. There
is a distinct possibility that frequent hypos in a Type 1 can cause
long term brain damage.

Hyperglycemia happens when the blood glucose levels rise to a high
level. This, like hypoglycemia, is also a dangerous situation, though
more sudden deaths occur from hypo than hyper. The subject is beyond
the scope of this introduction and should be researched in our library
using hyperglycemia, DKA, or ketones as key words in separate
searches.

Feet

I mentioned early in this file that our feet and other peripheral
parts of our bodies may be affected by DM. This is caused by
peripheral neuropathy (the blood isn't able to plow through to feed the
nerves in the areas farthest from our hearts) and can be very
unpleasant and, if not well looked after, very dangerous. It is
essential that your check your feet every day for signs of cuts,
blisters or wounds that you may not feel. A regular check up by a
podiatrist/chiropodist is also required. The danger of not looking
after your feet lies in infections that may lead to gangrene and
eventual amputation. Never go barefoot again, even at home.


Eyes

There are two main things that need to be said about eyes here. First,
diabetes affects the viscosity of the fluid in our eyes and thus our
ability to focus and to see clearly. As the diabetes develops we may
suffer a deterioration of eyesight that we may not be aware of because
it has happened gradually. As we get the diabetes under control, the
viscosity usually changes rapidly and we become aware of changes in
our vision. This is quite normal and should settle down within a few
weeks or months. It is a good idea not to get new glasses until the
situation has stabilized.

The second aspect about DM eyes is the long-term danger of our sight
being affected by the excess too-delicate blood vessels the eye
produces when sugar clogs the regular ones. This is called
retinopathy, and it can cause blindness without any prior discernible
(to you)symptoms. It is absolutely essential to get our eyes examined
at least once a year *with the pupils dilated* so that our retinas may
be examined in greater detail.


Testing

There is a wide variety of blood glucose test meters available. They
are useful indicators as to what our blood glucose may be doing at any
given moment. It is beneficial to use a meter, especially during the
first few months after diagnosis, on a regular basis so that we can
see how different foods, exercise, stress, lifestyle changes and
medication affects our BG levels throughout the day. It is recommended
that we keep a chart or spreadsheet of the readings and the times we
test as well as when we ate and exercised so that we can see the
effects of all of these on our BG levels. Section 20, Meters and
Supplies, is the forum section devoted to these matters.

Note: Were you told to test with a meter? If not, you may need a new
doctor. Were you told to test only upon awaking (fasting)? You may
need a new doctor. Were you given a HbA1c blood test, sometimes called
a Glycohemoglobin? Did your doctor tell you the results, or give you
copies, of these and other tests?


Hot and Cold

The changes that DM makes to our metabolisms can affect our reactions
to changes in temperature. Not everyone is affected and not everyone
has the same affects. In my case before diagnosis I felt cold, even on
quite warm days, since I have been in control of my DM I no longer
feel the cold as much and can feel more comfortable in cooler
temperatures.


A Little Problem with Sugar

Unfortunately, it is all too often the case that public perception of
diabetes is that it is just a matter of not eating sugar. Nothing
could be further from the truth. Fat is the enemy of Type 2 DM,
although not a problem with Type 1 DM. We need carbohydrates
to live and carbohydrates are turned into sugar in our bodies. Of
course excessive sugar is not good for us but be assured that the so
called "diabetes" foods are no better for us than ordinary foods eaten
in a sensible way.


We Caused Our Own Problems

Another popular myth!  Diabetes is a genetic failing. The onset of
diabetes can result in being overweight, though not in every case, and
being overweight is not conducive to good control. But being
overweight does NOT cause diabetes. There are plenty of enormous
people who will never get diabetes, and plenty of slim ones who will.


The Gray/Silver Ribbon

The gray ribbon was "invented" on this forum in December 1996. By May,
1997, President Clinton was wearing one. Wear one to promote awareness of
diabetes and the need for a cure.


Moods

Oh, yes. You'll have them with DM. Please feel free to look at any
file that has COPING as a keyword and you'll see what we've all
experienced. Diabetes is a chronic disease with no cure as yet. That
alone can be pretty depressing.



Theses topics and many more are discussed in our libraries and are
frequently the subject of message exchanges in the forum sections.

This, being an introduction to life after diagnosis, is not intended
to cover every aspect of diabetes and you should examine our libraries
to find the topics that relate to the questions you may have, or you
may post questions in the News and Newcomers message section. However,
there are a number of matters that you may come across from reading
forum messages and library files that need to be addressed in this
introduction. Please note that I am merely introducing the topics and
that further reading is recommended. No question will ever be
considered too small or unimportant to answer; we cannot help with
specific questions unless you make yourself know to us in the News and
Newcomers section. We are all involved with diabetes in one way or
another: many of us are diabetics; others are parents, relatives or
friends of diabetics; we have some members of the medical profession
who gladly give us some of their time and professional experience; we
are more of a family here than just a group of diabetics.