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If you have diabetes, your body cannot make or properly use insulin. Insulin is a hormone that helps control the sugar, or glucose, in your blood. Glucose is the main source of fuel for your body.

When you have diabetes, the levels of blood glucose are too high. High blood glucose can cause symptoms such as blurred vision, frequent urination, increased thirst, unintended weight loss, slow healing sores, and feelings of hunger and tiredness. However, some people with diabetes do not have symptoms.

Diabetes is a serious disease. Over time, diabetes that is not well controlled causes serious damage to the eyes, kidneys, nerves, and heart.

About 18.2 million Americans, or 6.2 percent of the population, have diabetes. Thirteen million people have diagnosed diabetes, while an estimated 5.2 million people are undiagnosed. More than 8 million people 60 years or older have diabetes. This figure represents 18.3 percent of that age group.

About 5 to 10 percent of people with diabetes have type 1 diabetes. Type 1 diabetes usually occurs in children, teenagers, or adults under age 30. In people with type 1 diabetes, the body can no longer produce insulin.

About 90 percent of people in the United States with diabetes have type 2 diabetes. It is most common in adults over age 40, and the risk of getting type 2 diabetes increases with age. With this form of diabetes, the body does not always produce enough insulin or does not use insulin efficiently. Being overweight and inactive increases the chances of developing type 2 diabetes.

Type 2 diabetes is also more common in people with a family history of diabetes and in African Americans, Hispanic Americans, American Indians and Alaska Natives, and Asian and Pacific Islanders.

Some women develop gestational diabetes during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life.

People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too high or too low. About two-thirds of people with diabetes die of heart disease, so it is also important to control blood pressure and cholesterol. This may require taking medications prescribed by a doctor.

When blood glucose levels drop too low, a condition known as hypoglycemia, a person can become nervous, shaky, and confused. Judgment can be impaired. If blood glucose falls too low, a person can faint.

A person can also become ill if blood glucose levels rise too high, a condition known as hyperglycemia. Diabetics may go into a coma if their blood sugar levels rise too high.

Strict control of blood glucose as well as blood pressure and cholesterol is the best defense against the serious complications of diabetes. People who take steps to control their diabetes can make a big difference in their health. If you have diabetes, stick to a diet plan, monitor your blood sugar, exercise regularly, take prescribed medication, and make healthy lifestyle choices.

Diabetes is a disease that prevents the body from properly converting foods into the energy needed for daily activity. Understanding how diabetes develops starts with knowing what happens when the body digests food.

When you eat, your body changes most of the food into a form of sugar called glucose. Glucose travels through the blood stream to "fuel," or feed your cells. It is the main source of fuel for your body.

For glucose to get into cells, insulin must be present. Insulin is a hormone made by the pancreas, a large organ behind the stomach.

If your body does not make enough insulin or if the insulin doesn't work the way it should, glucose can't get into your cells. It remains in your blood, while the cells are starved of energy. The level of glucose in your blood then gets too high, causing diabetes.

Over the years, high levels of glucose in the blood damage nerves and blood vessels. This can lead to complications such as heart disease and stroke, kidney disease, blindness, nerve damage, gum infections, and lower limb amputation.

There are three main forms of diabetes: type 1, type 2 and gestational diabetes. Type 1 diabetes is an autoimmune disease. An autoimmune disease occurs when the body's system for fighting infection -- the immune system -- turns against a part of the body.

In type 1 diabetes, the immune system attacks the insulin-producing cells in the pancreas and destroys them. The pancreas then produces little or no insulin.

At present, scientists do not know exactly what causes the body's immune system to attack the cells, but they believe that both genetic factors and environmental factors, such as viruses, are involved. Studies have begun to try to identify these factors and prevent type 1 diabetes in people at risk.

Type 2 diabetes -- the most common form -- is linked to obesity, high blood pressure, and high levels of bad cholesterol called triglycerides, and low levels of good cholesterol called high density lipoprotein or HDL. About 80 percent of people with type 2 diabetes are overweight. Being overweight can keep your body from using insulin properly.

When type 2 diabetes is diagnosed, the pancreas is usually producing some insulin, but not as much as needed. After several years, insulin production tends to decrease in people with type 2 diabetes.

Being over 45 years of age and overweight or obese raises the risk of developing type 2 diabetes. Other risk factors include:

• having a first-degree relative -- a parent, brother, or sister -- with diabetes
• being African American, American Indian or Alaska Native, Asian American or Pacific Islander, or Hispanic American/Latino.
• having gestational diabetes, or giving birth to at least one baby weighing more than 9 pounds
• having blood pressure of 140/90 or higher, or having been told that you have high blood pressure.
• having abnormal cholesterol levels -- an HDL cholesterol level of 35 or lower, or a triglyceride level of 250 or higher
• being inactive or exercising fewer than three times a week.

Before people develop type 2 diabetes, they usually have pre-diabetes -- a condition in which blood glucose levels are higher than normal, but not yet high enough for a diagnosis of diabetes.

People with pre-diabetes are more likely to develop diabetes within 10 years and also are more likely to have a heart attack or stroke. Pre-diabetes is common in America, according to new estimates. About 41 million people, or 40 percent of U.S. adults ages 40 to 74, have pre-diabetes.

Some women develop gestational diabetes during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin.

Diabetes tends to run in families, but other factors add to the risk of getting diabetes. For example, being overweight and under-active triggers diabetes in people who are at risk.

The two most common forms of diabetes are type 1 and type 2. In people with type 1 diabetes the body stops making insulin. Currently, there is no way to delay or prevent this form of diabetes.

Type 2 diabetes can be prevented in people who are at an increased risk for developing type 2 diabetes or have a condition called pre-diabetes. Pre-diabetes is a condition in which blood glucose levels are higher than normal but not yet high enough for a diagnosis of diabetes. People with pre-diabetes are more likely to develop diabetes within 10 years and are also more likely to have a heart attack or stroke.

A recent study by the National Institute of Diabetes and Digestive and Kidney Diseases, called the Diabetes Prevention Program, showed that people with pre-diabetes can sharply lower their chances of developing the disease through modest weight loss with diet and exercise.

That same study showed that changes in diet and exercise were especially effective in curbing the development of diabetes in older people. In fact, the development of diabetes dropped by 71 percent in adults 60 and older who were enrolled in the study.

Making modest lifestyle changes can often prevent or delay type 2 diabetes in people who are at risk. Here are some tips that may help.

• Reach and maintain a reasonable body weight. Your weight affects your health in many ways. Being overweight can keep your body from making and using insulin properly. It can also cause high blood pressure. Recent studies have shown that losing even a few pounds can help reduce your risk of developing type 2 diabetes.
• In the Diabetes Prevention Program, people who lost 5 to 7 percent of their body weight significantly reduced their risk of type 2 diabetes. So if you weigh 200 pounds, losing only 10 pounds can make a difference.
• Make wise food choices most of the time. What you eat has a big impact on your health. By making wise food choices, you can help control your body weight, blood pressure, and cholesterol.
• Be physically active every day. Regular exercise tackles several risk factors at once. It helps you lose weight, control your cholesterol and blood pressure, and improve your body's use insulin. People in the Diabetes Prevention Program study who were physically active 30 minutes a day 5 days a week reduced their weight and risk of type 2 diabetes. Many chose walking for exercise.
• Take your prescribed medications. Some people need medication to help control their blood pressure or cholesterol levels. If you do, take your medicines as directed. Ask your doctor whether there are any medicines you can take to help you prevent type 2 diabetes.

Researchers are working hard to uncover the genetic and environmental factors that may put people at risk for obesity, pre-diabetes, and diabetes. As they learn more about the changes in the body that lead to diabetes, researchers will develop ways to prevent and cure the different stages of this disease.

Diabetes is often called a "silent" disease because many people have no signs or symptoms before they are diagnosed. Symptoms can also be so mild that you might not notice them. More than 5 million people in the United States have type 2 diabetes and do not know it.

The signs of diabetes are

• being very thirsty
• urinating often
• feeling very hungry or tired
• losing weight without trying.
• having sores that heal slowly
• having dry, itchy skin
• losing the feeling in your feet or having tingling in your feet
• having blurry eyesight.

Symptoms of type 1 diabetes, which occurs most often in children and young adults, usually develop over a short period of time. The symptoms for type 2 diabetes develop more gradually.

Gestational diabetes develops only during pregnancy and usually disappears after delivery. However, the mother is at increased risk of getting type 2 diabetes later in life.

Doctors use the following tests to diagnose diabetes.

• A fasting plasma glucose, or FPG test, measures your blood glucose after you have gone at least 8 hours without eating. Doctors use this test to detect diabetes or pre-diabetes.
• An oral glucose tolerance test, or OGTT, measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a sweet beverage. Doctors use this test to diagnose diabetes or pre-diabetes. Doctors also use the oral glucose tolerance test to diagnose gestational diabetes in pregnant women
• In a random plasma glucose test, your doctor checks your blood glucose without regard to when you ate your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes.

If any of these tests show that you might have diabetes, your doctor will need to repeat the fasting plasma glucose test or the oral glucose tolerance test on a different day to confirm the diagnosis.

The fasting plasma glucose or FPG test is the preferred test for diagnosing diabetes and is most reliable when done in the morning.

Because type 2 diabetes is more common in older people, especially in people who are overweight, doctors recommend that anyone 45 years of age or older be tested for diabetes. If you are 45 or older and overweight, getting tested is strongly recommended.

Diabetes is a serious disease that can lead to pain, disability, and death. Sometimes people have symptoms but do not suspect diabetes. They delay scheduling a checkup because they do not feel sick.

Many people do not find out they have the disease until they have diabetes complications, such as blurry vision or heart trouble. Finding out early if you have diabetes is important because treatment can prevent damage to the body from diabetes.

Diabetes cannot be cured, but it can be controlled. Strict control of blood glucose, or blood sugar, as well as blood pressure and cholesterol is the best defense against the serious complications of diabetes.

People with type 1 diabetes control their blood sugar with insulin injections and frequent self-monitoring of blood glucose. People with type 2 diabetes generally control their blood sugar with oral medications and, in some cases, insulin. Sometimes a person with type 2 diabetes can control blood glucose levels with diet and exercise alone.

Good control of blood glucose requires

• following a meal plan
• getting regular physical activity
• taking diabetes medicine every day
• checking blood glucose as recommended
• monitoring your diabetes ABCs.

Diet and Exercise

Follow a Meal Plan

Healthy eating is very important to lowering blood glucose levels, and people with diabetes should have their own meal plan. Ask your doctor to give you the name of a dietitian or a diabetes educator who can work with you to develop a meal plan.

In designing a meal plan, the dietitian considers the patient's weight and daily physical activity. For overweight patients, a weight loss plan is a must for proper blood glucose control. Your dietitian can help you plan meals to include foods that you and your family like to eat and that are good for you. Ask your dietitian to include foods that are heart healthy to reduce your risk of heart disease.

People with diabetes don't need to eat special foods. You can eat foods that are low in fat, salt, and sugar and high in fiber, such as beans, fruits, vegetables, and grains. Eating right will help you reach and stay at a weight that's good for your body, keep your blood glucose in a desirable range, and prevent heart and blood vessel disease.

Get Regular Physical Activity

Regular physical activity is important for people with diabetes. Taking part in a regular fitness program has been shown to improve blood glucose levels in older people whose levels are high.

Exercise is especially good for people with diabetes because

• exercise helps keep weight down
• exercise helps insulin work better to lower blood glucose
• exercise is good for your heart and lungs
• exercise gives you more energy.

Before you begin exercising, talk with your doctor. Your doctor may check your heart and your feet to be sure you have no special problems. If you have high blood pressure or eye problems, some exercises like weightlifting may not be safe. Your health care team can help you find safe exercises.

Walking, swimming, dancing, riding a bicycle, playing baseball, and bowling are all good ways to exercise. You can even get exercise when you clean house or work in your garden.

Try to exercise almost every day for a total of about 30 minutes. If you haven't exercised lately, begin slowly. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day.

Medications

Take Your Diabetes Medicine Every Day

Insulin and diabetes pills are the two kinds of medicines used to lower blood glucose.

You need insulin if your body has stopped making insulin or if your body doesn't make enough. Everyone with type 1 diabetes needs insulin, and many people with type 2 diabetes do, too.

Insulin can't be taken as a pill. You will give yourself shots every day or use an insulin pump. Insulin pumps are small machines that connect to narrow tubing, ending with a needle just under the skin near the abdomen. Insulin is delivered through the needle.

If your body makes insulin, but the insulin doesn't lower your blood glucose, you may need diabetes pills. Some pills are taken once a day, and others are taken more often. Ask your health care team when you should take your pills.

Be sure to tell your doctor if your pills make you feel sick or if you have any other problems. Remember, diabetes pills don't lower blood glucose all by themselves. You will still want to follow a meal plan and exercise to help lower your blood glucose.

Sometimes, people who take diabetes pills may need insulin shots for a while. If you get sick or have surgery, the diabetes pills may no longer work to lower your blood glucose.

Many people with type 2 diabetes do not need insulin or diabetes pills. They can take care of their diabetes by using a meal plan and exercising regularly.

Self-monitoring

Check Your Blood Glucose as Recommended

The best way to find out how well you are taking care of your diabetes is to check your blood to see how much glucose is in it. If your blood has too much or too little glucose, you may need a change in your meal plan, exercise plan, or medicine.

Ask your doctor how often you should check your blood glucose. Some people check their blood glucose once a day. Others do it three or four times a day. You may check before eating, before bed, and sometimes in the middle of the night.

Your doctor or diabetes educator will show you how to check your blood using a blood glucose meter. Your health insurance or Medicare may pay for the supplies and equipment you need.

Monitor Your Diabetes ABCs

Heart disease and stroke are the leading causes of death for people with diabetes. If you have diabetes, heart disease is more likely to strike you and at an earlier age than someone without diabetes. Therefore, people with diabetes need to control their A1C or blood glucose average, their Blood pressure, and their Cholesterol -- the ABCs of diabetes.

The A1C test, also called the hemoglobin A1C test, shows overall blood glucose for the past 3 months. It shows how much glucose is sticking to your red blood cells. The doctor does this test to see what your blood glucose is most of the time. This test should be done at least twice a year.

An A1C test result of under 7 usually means that your diabetes treatment is working well and your blood glucose is under control. If your A1C is above 7 your blood glucose is too high and you have a greater chance of getting diabetes complications.

If your A1C is 8 or above, take action. You need a change in your meal plan, exercise plan, or diabetes medicine to lower your chance of getting diabetes problems like kidney damage. Talk with your health care provider about your A1C goal.

High blood pressure makes your heart work too hard. This leads to strokes and other problems such as kidney disease. Your blood pressure should be checked at every doctor visit. The target blood pressure for most people with diabetes is less than 130/80. Talk with your health care provider about your blood pressure goal.

Low density lipoprotein, or LDL, is the bad cholesterol that builds up in your blood vessels. It causes the vessels to narrow and harden, which can lead to a heart attack. Your doctor should check your LDL at least once a year. The target LDL cholesterol for most people with diabetes is less than 100. Talk with your health care provider about your cholesterol goal.

Foot Care

Foot care is very important for people with diabetes. High blood glucose levels and a reduced blood supply to the limbs cause nerve damage that reduces feeling in the feet. Someone with nerve damage may not feel a pebble inside his sock that is causing a sore. One may not feel a blister caused by poorly fitting shoes. Foot injuries such as these can cause ulcers, which may lead to amputation.

People with diabetes should check their feet every day and watch for any cuts, sores, red spots, swelling, and infected toenails. Sores, blisters, breaks in the skin, infections, or buildup of calluses should be reported right away to a podiatrist or a family doctor.

Skin Care

Skin care is very important, too. Because people with diabetes may have more injuries and infections, they should protect their skin by keeping it clean, using skin softeners to treat dryness, and taking care of minor cuts and bruises.