1. DIABETES
Diabetes is a chronic, progressive disease characterized by the abnormal metabolism of
carbohydrates, proteins and fats leading to hyperglycemic state. The disease is more prevalent among
Hispanics, Native Americans, Pacific islanders and African Americans. Frequent urination, excessive
thirst and hunger are the main acute symptoms of any type of diabetes.
TYPES
Diabetes includes 4 clinical classes.
A) Type 1: This occurs when the body's immune system attacks and destroys certain cells in the
pancreas called beta cells. But when the beta cells are destroyed, no insulin can be produced, and
the glucose stays in the blood instead, where it can cause serious damage to all the organ systems
of the body.
B) Type 2: In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the
insulin. Obesity, weight gain in adulthood and physical inactivity are the environmental factors
affecting the progression of diabetes.
C) Gestational Diabetes: This is the diabetes developed during the pregnancy.
D) Other specific types of diabetes: These are caused by genetic defects in beta- cell function or
insulin action, diseases of the pancreas or induced by drugs or chemicals.
DIAGNOSING DIABETES- 4 TESTING OPTIONS
A1C >6.5%
Acute symptoms plus casual plasma glucose >200mg/dL (11.1 mmol/L)
Fasting plasma glucose >126 mg/dL (7.0 mmol/L)
2-hour plasma glucose >200 mg/dL (11.1 mmol/L) during OGTT (75-g glucose)
DIANOSIS OF PREDIABETES
Impaired Fasting Plasma Glucose (IFG) 100gm/dL to 125 gm/dL
Impaired Glucose Tolerance (IGT) 2 hours OGTT values of 140mg/dL to 199 mg/dL
KEY CONCEPTS AND FACTS ON TYPE 2 DIABETES
• Diabetics need to check their blood sugar before and after exercising. Diabetics who do not check
their blood sugar run the risk of hypoglycemia.
DIABETES AWARENESS FOR YOU AND YOUR FAMILY
Priya Merin Mathew, RN, MSN/Ed, CDE, CMSRN

2. • Cautions with diabetes Medications in older adults: Be aware of how your diabetes medicines
affect your kidney and liver functions. Know the signs and symptoms of high and low blood
sugar. Older people are more at risk of low sugar while on insulin.
• Monitoring total grams of carbohydrate intake is the key strategy in achieving the glucose
control. 30-45 grams carbohydrate for females and 45-60gms carbohydrate for males is what the
recommended amount.
• The energy per gram is as follows: Carbohydrate - 4 Calories, Fats - 9 Calories and Protein - 4
Calories.
• It is recommended that persons with diabetes include foods containing 25-30 grams fiber per day.
• Many food products containing non-nutritive sweeteners may also contain energy and
carbohydrate from other sources that need to be accounted for. Whether you decide to use Stevia
or Splenda, you can get health benefits without the risks if you just use a little moderation in your
diet.
• 150 minutes of accumulated moderate intensity aerobic physical activity per week as well as
resistance training (it is a form of strength training in which each effort is performed against a
specific opposing force generated by resistance) 3 times per week is recommended for glycemic
control and weight loss.
• Excessive amounts of alcohol (3 or more drinks per day) on a consistent basis can contribute to
high sugars. Moderate amounts of alcohol (less than 1 drink per day for adult women and less
than 2 drinks per day for adult men) ingested with food have minimal, if any, effect on glucose
and insulin concentrations.
• A moderate weight loss of 5% to 10% can reduce the risk of developing type 2 diabetes and
improve glycemia in individuals who are insulin resistant and that have pre-diabetes. A healthy
eating plan consists of multiple servings of fruits and vegetables, whole grains, legumes, low-fat
dairy foods, fish, lean meats, poultry and healthy fats.
• Low-carbohydrate meals are not recommended for diabetic persons as foods containing
carbohydrates are important components of a healthy eating pattern when consumed in the
recommended portions.
• Daily Vitamin D supplementation is a vital component that plays a role in many diseases like
diabetes and cardiovascular diseases although it has not been prospectively proven.
• Women with diabetes must strive for normal sugars during the first 10 weeks after conception to
protect the fetus during organogenesis and avoid peri-natal complications and birth defects.
• Know your blood cholesterol goal: LDL (bad cholesterol) less than 100mg/dL (if you don’t have
heart disease), LDL less than 70mg/dL if you already have heart disease), HDL (good
cholesterol) more than 40mg/dL in men and more than 50mg/dL in women, triglycerides less than
150mg/dL.
• Get a dilated eye exam by an eye care specialist every year and have a urine test for protein

3. (micro albumin test) done every year. Have a blood test for serum creatinine done at least once a
year.
• You can help keep your nerves and blood vessels healthy by managing your ABCs– that is, your:
A1C
Blood pressure
Cholesterol level.
• You can raise your blood sugar about 50 milligrams of glucose per deciliter (mg/dl) with 15
grams of fast-acting carbohydrate. Examples include 4 glucose tablets, 1/2 cup of fruit juice, 6 or
7 Lifesavers candies, or 1/2 cup of regular soda.
• No fruit recommended after 5-6pm (dinner time) and no snack at bedtime unless the bedtime
sugar is <110.
DIABETES CARE SCHEDULE
EVERY 3 MONTHS EVERY 6 MONTHS EVERY YEAR
Regular office visits
A1C test (If your blood sugar is not
stable)
Blood pressure check
Weight check
Foot check
A1C test (If your blood sugar is
stable)
Dental Exam
Physical Exam
Comprehensive Foot Exam
Blood cholesterol and blood fat
tests
Kidney tests
Dilated eye exam
Flu shot
REFERENCES
Common questions about blood sugar (cited 2012 March 8). On the internet at
http://www.ghc.org/healthAndWellness/index.jhtml?item=/common/healthAndWellness/conditions/diabet
es/monitorFAQ.html.
Mensing Carole , RN, MA, CDE, FAADE, “The Art and Science of Diabetes Self-Management
Education Desk Reference” by AADE, 2nd edition, 2011; 3-759
American Association of Diabetes Educators. “Caring for your diabetes”, November ’10, pg 3-
26.