Diabetes is the main cause of kidney failure, limb amputation, and new-onset blindness in adults. People with diabetes are also two to four times more likely than people without diabetes to develop heart disease.
If you find out early that you have diabetes, then you can get treatment to prevent damage to the body so don’t ignore symptoms.
You may already have pre-diabetes
Pre-diabetes, also called impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), is a condition in which your blood glucose (blood sugar) levels are higher than normal but not high enough for a diagnosis of diabetes.
Having pre-diabetes puts you at higher risk for developing type 2 diabetes.
If you have pre-diabetes, you are also at increased risk for developing heart disease.
Pre-diabetes is becoming more common worldwide.
According to new estimates provided by the U.S. Department of Health and Human Services; About 40 percent of U.S. adults ages 40 to 74 or 41 million people had pre-diabetes in 2000. New data suggest that at least 54 million U.S. adults had pre-diabetes in 2002. Those with pre-diabetes are likely to develop type 2 diabetes within 10 years, unless they take steps to prevent or delay diabetes. The results of the Diabetes Prevention Program showed that modest weight loss and regular exercise can prevent or delay type 2 diabetes.
Diabetics can control their blood glucose levels through a combination of healthy eating, exercise, and weight loss.
Symptoms include; increased thirst, increased hunger, fatigue, increased urination, especially at night, weight loss, blurred vision, sores that do not heal

What is type 2 diabetes?
Can type 2 diabetes be prevented?
What are the signs and symptoms of type 2 diabetes?
Should I be tested for diabetes?
What does having pre-diabetes mean?
Besides being older and overweight, what other factors increase my risk for type 2 diabetes?
How can I reduce my risk?
Making Changes to Lower My Risk

What is type 2 diabetes?

Diabetes is a disease in which blood glucose levels are above normal. People with diabetes have problems converting food to energy. After a meal, food is broken down into a sugar called glucose, which is carried by the blood to cells throughout the body. Cells use the hormone insulin, made in the pancreas, to help them process blood glucose into energy.

People develop type 2 diabetes because the cells in the muscles, liver, and fat do not use insulin properly. Eventually, the pancreas cannot make enough insulin for the body’s needs. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Over the years, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation.

Can type 2 diabetes be prevented?

Research has demonstrated that people at risk for type 2 diabetes can prevent or delay developing type 2 diabetes by losing a little weight. The results of the Diabetes Prevention Program (DPP) showed that moderate diet changes and physical activity can delay and prevent type 2 diabetes. Participants in this Federally funded study of 3,234 people at high risk for diabetes experienced a 5- to 7-percent weight loss. For example, a 5- to 7-percent weight loss for a 200-pound person would be 10 to 14 pounds.

Study participants were overweight and had higher than normal levels of blood glucose, a condition called pre-diabetes, also called impaired glucose tolerance. Both pre-diabetes and obesity are strong risk factors for type 2 diabetes. Because of the high risk for diabetes among some minority groups, about half of the DPP participants were African American, American Indian, Asian American, Pacific Islander, or Hispanic/Latino.

DPP participants also included others at high risk for developing type 2 diabetes, such as women with a history of gestational diabetes and individuals aged 60 and older.

The DPP tested two approaches to preventing diabetes: lifestyle change (a program of healthy eating and exercise) and the diabetes drug metformin. People in the lifestyle change group exercised about 30 minutes a day 5 days a week, usually by walking, and lowered their intake of fat and calories. Those who took the diabetes drug metformin received information on exercise and diet. A third group only received information on exercise and diet.

The results showed that people in the lifestyle change group reduced their risk of getting type 2 diabetes by 58 percent. In the first year of the study, people lost an average of 15 pounds. Lifestyle change was even more effective in those aged 60 and older. They reduced their risk by 71 percent. People receiving metformin reduced their risk by 31 percent.

Types of Diabetes

The three main kinds of diabetes are type 1, type 2, and gestational diabetes.

Type 1 Diabetes

Type 1 diabetes, formerly called juvenile diabetes or insulin-dependent diabetes, is usually first diagnosed in children, teenagers, or young adults. In this form of diabetes, the beta cells of the pancreas no longer make insulin because the body’s immune system has attacked and destroyed them. Treatment for type 1 diabetes includes taking insulin shots or using an insulin pump, making wise food choices, exercising regularly, controlling blood pressure and cholesterol, and some people taking aspirin.

Type 2 Diabetes

Type 2 diabetes, formerly called adult-onset or non-insulin-dependent diabetes, is the most common form of diabetes. People can develop type 2 diabetes at any age, even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals. People who are overweight and inactive are more likely to develop type 2 diabetes.

Treatment includes taking diabetes medicines, making wise food choices, exercising regularly, controlling blood pressure and cholesterol, and some people taking aspirin daily.

Gestational Diabetes

Some women develop gestational diabetes late in pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had gestational diabetes 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.

What are the signs and symptoms of type 2 diabetes?

More than 6 million people in the United States have type 2 diabetes and do not know it. Many have no signs or symptoms. Symptoms can also be so mild that you might not even notice them. Some people have symptoms but do not suspect diabetes.

Symptoms include

Increased thirst, increased hunger, fatigue, increased urination, especially at night,
weight loss, blurred vision, sores that do not heal.

Many people do not find out they have the disease until they have diabetes complications, such as blurry vision or heart trouble. If you find out early that you have diabetes, then you can get treatment to prevent damage to the body.

Who should be tested for diabetes?

Anyone 45 years old or older should consider getting tested for diabetes. If you are 45 or older and overweight getting tested is strongly recommended. If you are younger than 45, overweight, and have one or more of the risk factors, you should consider getting tested. Ask your doctor for a fasting blood glucose test or an oral glucose tolerance test. Your doctor will tell you if you have normal blood glucose, pre-diabetes, or diabetes.

What does having pre-diabetes mean?

Pre-diabetes means your blood glucose is higher than normal but lower than the diabetes range. It also means you are at risk for getting type 2 diabetes and heart disease. However, you can reduce the risk of getting diabetes and even return to normal blood glucose levels with modest weight loss and moderate physical activity. If you are told you have pre-diabetes, have your blood glucose checked again in 1 to 2 years.

Risk for type 2 diabetes

Being older and overweigh.
Do you have a parent, brother, or sister with diabetes?
Is your family background is Alaska Native, American Indian, African American, Hispanic/Latino, Asian American, or Pacific Islander?
Have you had gestational diabetes, or gave birth to at least one baby weighing more than 9 pounds?
Have high blood pressure? is 140/90 mm Hg or higher,
My cholesterol levels are not normal. My HDL cholesterol—“good” cholesterol—is below 35 mg/dL, or my triglyceride level is above 250 mg/dL.
I am fairly inactive. I exercise fewer than three times a week.
I have polycystic ovary syndrome, also called PCOS—women only.
On previous testing, I had impaired glucose tolerance (IGT) or impaired fasting glucose (IFG).
I have other clinical conditions associated with insulin resistance, such as acanthosis nigricans.
I have a history of cardiovascular disease.

The more items you checked, the higher your risk.

How can I reduce my risk?

You can do a lot to lower your chances of getting diabetes. Exercising regularly, reducing fat and calorie intake, and losing a little weight can help you reduce your risk of developing type 2 diabetes. Lowering blood pressure and cholesterol levels also helps you stay healthy.

If you are overweight

 Reach and maintain a reasonable body weight.
 Make wise food choices most of the time.
 Be physically active every day.

If you are fairly inactive

Then take this step:
Be physically active every day.

If your blood pressure is too high

 Reach and maintain a reasonable body weight.
 Make wise food choices most of the time.
 Reduce your intake of sodium and alcohol.
 Be physically active every day.
 Talk with your doctor about whether you need medicine to control your blood pressure.

If your cholesterol or triglyceride levels are too high

Make wise food choices most of the time.
Be physically active every day.
Talk with your doctor about whether you need medicine to control your cholesterol levels.

Making Changes to Lower Risk

Making big changes in your life is hard, especially if you are faced with more than one change. You can make it easier by taking these steps:

Make a plan to change behavior.
Decide exactly what you will do and when you will do it.
Plan what you need to get ready.
Think about what might prevent you from reaching your goals.
Find family and friends who will support and encourage you.
Decide how you will reward yourself when you do what you have planned.

Your doctor, a dietitian, or a counselor can help you make a plan. Consider making changes to lower your risk of diabetes.
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. Excess body weight can also cause high blood pressure.

Body mass index (BMI) is a measure of body weight relative to height. You can use BMI to see whether you are underweight, normal weight, overweight, or obese.

If you are overweight or obese, choose sensible ways to get in shape.

Avoid crash diets. Instead, eat less of the foods you usually have. Limit the amount of fat you eat.
Increase your physical activity. Aim for at least 30 minutes of exercise most days of the week.
Set a reasonable weight-loss goal, such as losing 1 pound a week. Aim for a long-term goal of losing 5 to 7 percent of your total body weight.

Make Wise Food Choices Most of the Time

What you eat drink and breath has a big impact on your health. By making wise food choices, you can help control your body weight, blood pressure, and cholesterol.

Take a look at the serving sizes of the foods you eat. Reduce serving sizes of main courses such as meat, desserts, and foods high in fat. Increase the amount of fruits and vegetables.
Limit your fat intake to about 25 percent of your total calories. For example, if your food choices add up to about 2,000 calories a day, try to eat no more than 56 grams of fat. Your doctor or a dietitian can help you figure out how much fat to have. You can also check food labels for fat content.
Limit your sodium intake to less than 2,300 mg—about 1 teaspoon of salt—each day.
Avoid alcohol
You may also wish to reduce the number of calories you have each day. People in the DPP lifestyle change group lowered their daily calorie total by an average of about 450 calories. Your doctor or dietitian can help you with a meal plan that emphasizes weight loss.
Avoid pollution
Keep a food and exercise log. Write down what you eat, how much you exercise—anything that helps keep you on track.
Inquire your doctor about what your ideal Body Mass Index should be.

Be Physically Active Every Day

Regular exercise tackles several risk factors at once. It helps you lose weight, keeps your cholesterol and blood pressure under control, and helps your body use insulin. People in the DPP who were physically active for 30 minutes a day, 5 days a week, reduced their risk of type 2 diabetes. Many chose brisk walking for exercise.

If you are not very active, you should start slowly. Talk with your doctor first about what kinds of exercise would be safe for you. Make a plan to increase your activity level toward the goal of being active at least 30 minutes a day most days of the week.

Choose activities you enjoy. Some ways to work extra activity into your daily routine include the following:

    * Take the stairs rather than an elevator or escalator.
    * Park at the far end of the parking lot and walk.
    * Get off the bus a few stops early and walk the rest of the way.
    * Walk or bicycle whenever you can.

Prescribed Medications
If these lifestyle changes don’t work, diabetes medications may be in order. Some people need medication to help control their blood pressure or cholesterol levels. If you do, take your medicines as directed. Ask your doctor about medicines to prevent type 2 diabetes. Depending on the agent, anti-diabetic medications may work by stimulating your pancreas to make more insulin, reducing the amount of glucose made by your liver, slowing the absorption of dietary carbohydrates (a major source of blood glucose), or increasing the sensitivity of cells to insulin. Examples include:
Sulfonylureas such as glipizide, glimepiride, glyburide
Biguanides such as metformin
Alpha-glucosidase inhibitors such as acarbose, miglitol
Thiazolidinediones such as pioglitazone, rosiglitazone
Meglitinides such as repaglinide, nateglinide
If your pancreas no longer makes insulin at all, you will have to resort to insulin injections

Nerve Decompression in Diabetic Neuropathy Relieves Pain and Protects Against Ulcer, Recurrence, and Amputation
D. Scott Nickerson, MD

Diabetic neuropathy remains a troubling problem with potential complications including severe pain, Charcot’s neuroarthropathy, foot ulcer, infections, amputation and early death. There are 100,000 amputations in diabetics annually. The idea that surgical treatment can usually relieve pain and prevent the devastating cascade of sequelae is new information to most physicians and surgeons. The evidence confirming the benefit of multiple decompressions of specific peripheral nerves is examined.
Methods:
The index report of surgical relief of neuropathic pain and reversal of sensory loss, five additional confirmatory reports, and a neuropathy decompression patient registry are reviewed.
Results:
Pain relief and recovery of protective sensation are achieved with 80-90% consistency. Almost complete freedom from subsequent ulcer formation or amputation is noted. A patient registry shows >90% subsequent reduction from expected amputation, ulceration, and recurrent ulceration rates.

Discussion and Conclusion:
To accept that nerve decompression can benefit a metabolic disease complication requires understanding that nerve size can be changed by diabetes. Ultrasound studies demonstrate this. Physiologically, intraneural sorbitol accumulates, establishing an osmotic gradient. Fluid migrates intraneurally, enlarging the nerve, as demonstrated in both animals and humans. Rigid, non-expansible fibro-osseous tunnels provide the anatomic locus for functional entrapment as nerve hypertrophies. Subsequent strangulation of vasa nervorum and interruption of antegrade axoplasmic flow complete the pathologic entrapment process. Surgical release of carpal and cubital tunnels relieve hand symptoms, and decompression of common peroneal, dorsal branch deep peroneal, and posterior tibial nerve and branches in their tunnels addresses the foot problems of the classically taught “stocking-glove” anaesthesia. Orthopedic foot and hand surgeons are properly trained to recognize and treat the 10 million Americans with diabetic neuropathy. The promise of decompression surgeries to restore comfort and sensation to patients with painful neuropathy and numbness deserves far wider appreciation and application.