What is Diabetes?

Diabetes is a chronic disease in which the body cannot properly control the amount of sugar in the bloodstream. People with diabetes have difficulties transporting sugar from the blood into the cells. This process requires insulin, a hormone produced by the pancreas. People with diabetes either lack insulin, or cannot use the insulin they produce. Consequently, they have high blood sugar, also called blood glucose. Chronic high blood sugar causes damage to nerves, blood vessels, and organs.

Pre-diabetes
People with pre-diabetes have higher than normal blood glucose levels, but that are not high enough to diagnose diabetes. People with pre-diabetes have normal to high levels of insulin, which their body cannot use efficiently (called insulin resistance). If not treated, pre-diabetes will eventually turn into type 2 diabetes.

Type 1 Diabetes
People with type 1 diabetes produce little to no insulin, but can use insulin efficiently when they take it intravenously (directly into the bloodstream). Type 1 diabetes is most commonly diagnosed in children and young adults (under the age of 30). Type 1 diabetes has previously been called "juvenile diabetes" and "insulin-dependent diabetes". Type 1 diabetics compose 10-15 percent of the diabetic population.

Type 2 Diabetes
Type 2 diabetics may have below normal, normal, or above normal insulin levels. They are unable to use insulin properly (insulin resistance). A high insulin level signifies increased efforts to reduce blood sugar levels. A lower than normal insulin level is a sign that the body's ability to produce insulin is becoming exhausted, generally caused by excess insulin production over a period of time. Type 2 diabetes is the most common type of diabetes.

Gestational Diabetes
Some women develop type 2 diabetes during the course of a pregnancy. Women who get gestational diabetes are more likely to develop type 2 diabetes later in life. Women who are most at risk for gestational diabetes include those with a family history of it, those who are obese, and those who have had or have pre-diabetes. Gestational diabetes occurs in 1-3 percent of all pregnancies.

Metabolic Syndrome
This term refers to a combination of pre-diabetes or type 2 diabetes, obesity (especially in the upper body), high cholesterol, high blood pressure, and kidney problems. While metabolic syndrome is not a diabetes diagnosis, similar health consequences can result.

What are the Consequences of Diabetes?

Hyperglycemia
Hyperglycemia, or high blood sugar, is the direct effect of diabetes. The immediate effects of high blood sugar include increased hunger, thirst, and urination frequency. Chronic hyperglycemia damages the nerves and blood vessels, which can lead to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and even amputations. However, these complications can be greatly reduced or delayed with proper treatment.

Diabetic Ketoacidosis (DKA)
DKA is a condition in which blood contains excessive ketones. Ketones are produced when the body is forced to use fat for energy instead of blood sugar. High ketones can cause pH, electrolyte, and fluid imbalances. DKA occurs almost exclusively in type 1 diabetics who have really high blood sugar levels, are sick, are not eating enough, or who have missed an insulin dose. It is treated with intravenous fluids and insulin. Without treatment, DKA can lead to coma and death. Contact your doctor immediately if you suspect you have DKA

Early DKA symptoms:

• Fast, deep breathing
• Vomiting
• Weakness

Later DKA symptoms:

• Abdominal pain
• Chest pain
• Confusion
• Dry mouth
• Fruity-smelling breath
• Headache
• Nausea
• Fatigue
• Increased thirst
• Increased urination
• Weight loss
• Coma

Hypoglycemia
Hypoglycemia means low blood sugar (less than 70 mg/dL). In diabetics, hypoglycemia is most commonly caused by the following factors:

• Eating too few carbohydrates
• Too much exercise
• Drinking too much alcohol
• Excessive medication
• Interactions between medications

Symptoms of hypoglycemia can include:

• Hunger
• Nervousness and shakiness
• Perspiration
• Dizziness or light-headedness
• Sleepiness
• Confusion
• Difficulty speaking
• Feeling anxious or weak
• Night sweats

Diabetics can check their blood sugar levels regularly to help prevent hypoglycemia. If it gets low, consume one serving (15 grams) of carbohydrate every 15 minutes until your blood sugar equals at least 70mg/dl. Then have a meal or snack within the hour. Glucagon, a hormone that raises blood sugar, may be prescribed in case of hypoglycemic emergencies. Make sure to tell your doctor and your registered dietitian when you experience hypoglycemia.

Examples of easy-to-grab carbohydrates to treat hypoglycemia:

• Glucose gel or 2-3 glucose tablets
• 1/2 cup of fruit juice or soda
• 1 cup of milk
• 5-6 pieces of hard candy
• 1-2 teaspoons of sugar or honey

What Causes Diabetes?

Type 1 diabetes is the result of damage to pancreatic cells and a consequent loss of insulin production. Loss of pancreatic cellular function is thought to be caused by:

• Environmental factors
• Autoimmune conditions
• Genetic predisposition (most common)

Type 2 diabetes occurs when cells throughout the body fail to respond to insulin. Causes of insulin resistance are related to one or more of the following factors:

• Obesity
• Upper body obesity
• Recent weight gain
• Genetic predisposition
• Inactivity
• Polycystic ovarian disease (women)

Signs and Symptoms

Diabetes symptoms include:

• Increased frequency of urination, especially at night
• Increased thirst
• Increased hunger
• Weight loss
• Blurred vision
• Sores that do not heal
• Fatigue
• Dry mouth
• Dry or itchy skin
• Impotence
• Recurrent infections
• Acanthosis nigricans*
*Acanthosis nigricans is a skin condition characterized by darkened skin patches usually found on the neck, under the arms, or in the groin.

Should I be Tested for Diabetes?

Some people may have diabetes and not notice any symptoms. You should consider getting tested if:

You are 45 years old or older, especially if you are overweight.

You are younger than 45 years, overweight, and answer yes to one or more of the following questions:

• Do you have a parent, brother, or sister with diabetes?
• Are you American Indian, African American, Asian American, Pacific Islander, or Hispanic American/Latino?
• Have you ever had gestational diabetes or given birth to at least one baby weighing more than nine pounds?
• Do you have high blood pressure (140/90 or higher)?
• Are your cholesterol levels outside a normal range? (HDL < 35 mm/dL and triglycerides > 250 mm/dL)
• Do you exercise less than three times a week?
• Do you have symptoms associated with diabetes?
• Do you have a history of cardiovascular disease?
• Have you had previous tests for diabetes in which your blood sugar was high?

How is Diabetes Diagnosed?

Three types of tests are used to diagnose diabetes:

• Fasting plasma glucose test
• Oral glucose tolerance test
• Random plasma glucose test

The oral glucose tolerance test is modified for the diagnosis of gestational diabetes.

How is Diabetes Treated?

The primary goal of treatment is to keep blood sugar within a normal range. In this way, people with diabetes can prevent or delay the affects of diabetes, including heart disease, kidney disease, skin sores, gum disease, and blindness. The secondary goal of treatment is to manage these conditions as necessary. Treatment will vary according to type and severity of diabetes, and may include:

• Meal planning
• Physical activity
• Medication
• Smoking cessation

Diabetics should monitor their blood sugar levels on a daily basis. Treatment is monitored by the diabetic and their healthcare team, which usually consists of a primary diabetes doctor (usually an internist, family practice doctor, or endocrinologist), a registered dietitian, and a diabetes educator (often a registered nurse). Other doctors, such as eye doctors, vascular surgeons, or foot specialists, may be consulted depending on the needs of the patient. The healthcare team will perform regular tests, evaluate blood sugar control, look for signs of tissue damage or disease, and modify treatment as necessary.

Measurements of Diabetes Control

Diabetics and their healthcare providers measure the effectiveness of diabetes treatment with various tests, including:

• Hemoglobin A1C
  Your average blood sugar level over a three month period can be determined by measuring your hemoglobin A1C, or glycosylated hemoglobin. Glucose binds to hemoglobin, a part of the red blood cell. Glycosylated hemoglobin refers to the percentage of hemoglobin that has "picked-up" glucose. The more glucose in the blood (such as in the case of high blood sugar), the higher the percentage. Your healthcare provider should perform an A1C test routinely. It typically involves having a small amount of blood drawn at a lab or at your doctor's office.
• Blood lipids (cholesterol screening)
  Your healthcare provider will periodically measure your blood lipids, including LDL (the "bad" cholesterol), HDL (the "good" cholesterol), and triglycerides, to assess and monitor your risk for cardiovascular diseases. Like the A1C test, this test also involves drawing a small amount of blood.
• Blood pressure
  Your healthcare provider will measure your blood pressure at every visit to monitor your cardiovascular health. You may be asked to check it yourself between visits at a pharmacy or grocery store blood pressure machine.
• Daily blood sugar
  Many diabetics must check their blood sugar daily using a device called a glucometer, which measures the blood sugar in a few drops of blood. Most diabetics need to check their blood sugar before eating, two hours after eating, and before bedtime. However, frequency varies depending on the individual recommendations of the diabetic's healthcare team. People taking insulin will need to check their blood sugar more frequently than those who do not take insulin.
• Urine ketones
  Testing your urine for ketones is important to avoid ketosis. It occurs most commonly in type 1 diabetics or in type 2 diabetics who rely completely on insulin to control blood sugar. You can purchase a urine ketone testing kit in your local pharmacy and perform the test at home. Test for ketones more frequently when beginning insulin treatment or changing your insulin dose. See your doctor immediately if a urine test shows medium to high levels.

You should check ketones if:
• Your fasting blood sugar is greater than 240 mg/dl
• Your blood sugar during the day is greater than 300 mg/dl
• You feel sick or nauseated. (Ketones can increase during illness.)
• At any other times specified by your healthcare team
• Treatment goals should be determined on an individual basis, considering age, type of diabetes, blood sugar history, and other health conditions, such as infection, heart disease, or kidney disease. Typical goals for treatment recommended by the American Diabetes Association are provided below. Women with gestational diabetes may need more stringent goals.

Diabetes Treatment: Meal Planning

A healthy diet can help control blood sugar and reduce your risk of cardiovascular disease, including heart disease and stroke. A registered dietitian can give you specific diet recommendations to meet your individual needs. General guidelines include the following:

• Monitor carbohydrates
  
Carbohydrate is the primary nutrient that determines blood sugar levels. All carbohydrates are broken down to small sugars in the stomach and absorbed by the bloodstream. Carbohydrate recommendations vary according to many factors, including type of diabetes, body weight and composition, physical activity, and medications. If you have type 1 diabetes, it's important to match your carbohydrate intake and insulin dose to ensure appropriate blood sugar control. If you have type 2 diabetes, reducing carbohydrate intake, choosing healthy carbohydrates, and eating them consistently throughout the day will help you to level off your blood sugar. Common sources of carbohydrates include breads, pasta, cereal, rice, desserts, fruit, corn, potatoes, beans, and milk. Healthier choices are minimally processed (fresh fruit vs. fruit juice), made with whole grains (such as 100% whole wheat pasta or bread), and low in sweet sugar. Balance carbohydrates with protein and fiber as discussed below. When monitoring carbohydrate intake, be careful to get enough throughout the day to avoid hypoglycemia, especially if you take medication, require insulin, or are physically active.
• Get enough protein
  
Include a source of protein, such as meats, eggs, milk, cheese, yogurt, beans, nuts, seeds, and tofu, at each meal and snack. Enough protein can help you to feel full, improve energy levels, and spare the use of lean tissue (such as muscle) for protein not provided by your diet or for energy when blood sugar is not available. However, excessive protein intake may increase the wear and tear on your kidneys over time.
• Choose healthy fats
  
Choose unsaturated fats instead of saturated or trans fats to reduce your risk for cardiovascular disease. Unsaturated fats, primarily found in plant-based foods and fish, such as vegetable oils, avocados, nuts, seeds, salmon, and tuna, may help to improve heart health and immune function. Saturated fats mostly come from animal products such as high-fat meats, high-fat dairy, butter, lard, and creams. Animal products also contain high amounts of cholesterol, which can further increase your risk for cardiovascular disease. Trans fats are found in stick margarine and shortening and certain baked goods and fried foods.
• Choose high-fiber foods
  
A high-fiber diet can help to reduce your blood cholesterol and may even help improve blood sugar control. In addition, high fiber foods provide vitamins, minerals, and other substances important for good health. Sources of fiber include whole grains, vegetables, whole fruits, dried fruits, nuts, seeds, beans, and lentils.
• Maintain a healthy body weight
  
A healthy body weight provides for better blood sugar control and reduces your risk for cardiovascular disease. If you are overweight, a modest weight loss (just 10 percent of your current body weight) can significantly improve your health. Pregnant women should consult their doctor to determine weight gain goals during pregnancy. Children should not try to lose weight, but rather, change their diet habits to enable a healthy weight in the future. See our Weight Management page for details about weight management and weight loss. (A link is provided at the bottom of this page.)
• Limit sodium
  
Excess sodium can lead to high blood pressure. While the most common source of sodium is table salt, other sources include certain seasonings, deli meats, and processed foods such as boxed or frozen dinners. The National Heart, Lung, and Blood Institute recommends the DASH diet (Dietary Approaches Stop Hypertension), which reduces sodium intake by encouraging a balanced diet of whole grains, fresh fruits and vegetables, low-fat dairy and meats, nuts, seeds, beans, and vegetable fats. The DASH diet can also help to reduce your blood cholesterol.
• Limit alcohol
  
If you drink alcohol, do so in moderation. Moderate alcohol intake is generally one drink per day for women and two drinks per day for men. One drink is defined as 12 oz of beer, 4 oz of wine, or 1.5 oz of liquor. Drinking alcohol can lead to hypoglycemia, especially for those who take insulin. This can be especially dangerous if the symptoms of hypoglycemia are interpreted by you or those around you as alcohol intoxication.

Diabetes Treatment: Physical Activity

Physical activity can help improve blood sugar control, encourage a healthy body weight, and reduce your risk for cardiovascular disease. It helps your muscles and organs to better use insulin when you are both excercising and resting. Being physically active also helps to lower blood pressure and reduce stress. Be sure to talk with your doctor before beginning an exercise program, and ease your way into it; don't overexert yourself.

People taking medications, especially those taking insulin, should check their blood sugar before exercising. If blood sugar is really high and you are in ketosis (see "What are the Consequences of Diabetes"), exercise can worsen the situation and lead to coma or death if not treated. If your blood sugar is low (less than 100 mg/dl), you need to have a snack consisting of one to two servings of carbohydrates before exercise. Always have a meal or snack after exercise to prevent hypoglycemia.

Physical activity can be anything that gets your body moving and your heart rate above resting. Thirty minutes three to five days per week is recommended, but something is always better than nothing. If you can't make time for thirty minutes, aim for something more realistic. In addition to planned activity, take small steps throughout the day to be more active, such as taking the stairs or carrying the basket at the grocery store instead of pushing the cart. It can make a big difference.

Diabetes Treatment: Medications

Type 1 diabetes
Type 1 diabetics are prescribed insulin, which the patient will administer intravenously. A doctor modifies dose frequency and amount as necessary according to diet, exercise, illnesses, other medications, and lifestyle, to control blood sugar appropriately.

Type 2 diabetes
Type 2 diabetics require oral medication and/or insulin if diet, exercise, and lifestyle changes fail to keep blood sugar within a normal range. Oral medications increase insulin sensitivity, reduce glucose production in the liver, increase the production of insulin, or block the breakdown of certain carbohydrates in the intestine. Insulin becomes necessary only when the patient's own ability to make it is compromised or has been exhausted.

Other medications
Other medications may be prescribed to prevent or treat high blood cholesterol, high blood pressure, or other complications associated with chronic high blood sugar.

Diabetes Treatment: Smoking Cessation

Diabetics who use any form of tobacco are at a greater risk for cardiovascular diseases such as heart disease, stroke, and peripheral arterial disease (plaque buildup that blocks blood flow in the arteries of the arms and legs). Quitting tobacco and limiting exposure to second-hand smoke can improve your health dramatically. Visit our Smoking Cessation page to learn more.

Can Diabetes be Prevented?

Most people can prevent type 2 diabetes by maintaining a healthy weight and exercising 30 minutes per day three to five times per week. A balanced diet with plenty of vegetables, whole grains, and that is low in fat and sugar can also help improve your overall health. At this time, there is no known way to prevent type 1 diabetes.

Is There a Cure for Diabetes?

There is not yet a cure for diabetes. However, much research is dedicated to finding one. Currently, the only known "cure" for type 1 diabetes is a pancreas transplant. However, this surgery is risky and generally discouraged. Researchers are also experimenting with transplanting just the cells in the pancreas that produce insulin. This treatment, though promising in theory, has not been successful enough to offer a viable option. Some people with type 2 diabetes are able to manage it with exercise and careful meal planning throughout their lives, but this is not a cure.

Tips for Managing Diabetes in College

Before coming to college

• Talk to your healthcare providers at home about your college plans. You may want to bring copies of your medical records with you to share with your healthcare providers in Austin. Your healthcare providers at home may also be able to help you find appropriate care within the Austin area.
• Check with your insurance company to ask about treatment options you have in the Austin area, including whether or not they will reimburse for charges incurred at a "campus health facility." You can see University Health Services (UHS) doctors for free, but there are charges for lab tests and other procedures. For information on student health insurance call 471-1040.
• If you have type 1 diabetes, assemble and pack a "sick day" medical kit. Include ketone strips, a thermometer, and any necessary over-the-counter medicines.
• Gather together your diabetes supplies, which may include a glucometer, a large supply of strips, insulin, oral medications, syringes, ketone strips, and glucose gel. Have your prescriptions transferred to a local pharmacy. The UHS pharmacy takes most major prescription drug insurance cards. Call 471-1824 to contact the UHS pharmacy.
• If applying for financial aid, remember to list expenses associated with diabetes care on the application.

Once at UT

• If you take insulin, inform your roommate or neighbors about the symptoms of hypoglycemia and ask if they would be willing to call for medical help or provide you with carbohydrate (such as glucose gel) if there is an emergency.
• Stock sources of carbohydrate in your dorm, apartment, or house. Carry some in your backpack and car as well.
• If you use syringes for insulin, obtain a sharps container from our office.
• Contact the UT Services for Students with Disabilities at 471-6259 to learn about special services that might be available to you.
• Get vaccinations as available, particularly the influenza vaccine and chickenpox vaccine if you have not already had the illness. Call 471-4955 for information on vaccines available at UHS.
• Carry medical identification.
• Take advantage of any resources available to you.

How Can UHS Help You?

Whether you've had diabetes for a long time, have recently been diagnosed, or are interested in prevention, there are resources available to you through University Health Services.

Concerned that you have diabetes?
If you are concerned you may have diabetes, call the 24-hour nurse advice line at 475-NURSE to get more information or to schedule an appointment with a UHS healthcare provider.

Need treatment for diabetes?
If you need treatment for diabetes, schedule an appointment with a UHS healthcare provider to discuss your treatment goals. Our doctors will provide referrals as necessary to ensure good care. Consultations with a registered dietitian are also available with a doctor's referral. For more information on seeing a dietitian, click on the link at the bottom of this page.

Interested in preventing diabetes?
We can help with:

• Handouts and brochures on healthy eating, exercise, smoking cessation, reducing blood pressure, managing blood cholesterol, and almost any other health topic
• Books on diabetes, meal planning, and cooking that you can check-out
• Exercise DVDs that you can check-out
• Free weight management and meal planning classes
• Heart healthy classes designed to identify and reduce your risk for cardiovascular disease
• Free diet analysis
• Individual sessions with a trained nutrition peer educator to learn more about healthy eating on the UT campus

For more information on these services, use the links at the bottom of this page.

Online Resources

Local support

General information about diabetes

Specific topics related to diabetes