Diabetes Today

The face of diabetes is changing everyday. Research and technology have made it possible for those living with diabetes to live long, healthy lives without the devastating side-effects of uncontrolled diabetes.

Athletes with diabetes have forever changed perceptions of what is possible in athletics and in life - despite living everyday with type 1 or type 2 diabetes.

When the pioneers of diabetes research developed the first insulin pump, they paved the way for the tubeless, wireless and discreet insulin pumps of today. When doctors told Phil Southerland's mother that her young child would likely not survive to see his 25th birthday - they inspired a mother-son team that would go on to make a positive impact in the world of diabetes. At age 25 Phil Southerland was racing as a professional cyclist and building what is now Team Type 1. In 2011, a book entitled "Not Dead Yet" will be released, detailing Phil Southerland's inspiring story of battling diabetes and overcoming - and creating a platform to help others worldwide affected by diabetes.

In the new "Diabetes Today" section, you will find a wealth of constantly updated information, resources and advice from the experts. The information is provided to help educate and empower everyone who his affected by diabetes. With appropriate diet, exercise, treatment and technology, we believe anyone with diabetes can achieve their dreams.

Type 1 and Type 2 Diabetes

Type 1 Diabetes

Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. In type 1 diabetes, the body does not produce insulin.

Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. Only 5% of people with diabetes have this form of the disease. With the help of insulin therapy and other treatments, even young children with type 1 diabetes can learn to manage their condition and live long, healthy, happy lives.

Type 2 Diabetes

Type 2 diabetes is the most common form of diabetes. Millions of Americans have been diagnosed with type 2 diabetes, and many more are unaware they are at high risk. Some groups have a higher risk for developing type 2 diabetes than others. Type 2 diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans, Native Hawaiians and other Pacific Islanders, as well as the aged population.

In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use glucose for energy. When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can lead to diabetes complications.

Information provided courtesy of the American Diabetes Association

Diabetes Statistics

Total prevalence of diabetes

Total: 25.8 million children and adults in the United States—8.3% of the population—have diabetes.

Diagnosed: 18.8 million people

Undiagnosed: 7.0 million people

Prediabetes: 79 million people*

New Cases: 1.9 million new cases of diabetes are diagnosed in people aged 20 years and older in 2010.

* In contrast to the 2007 National Diabetes Fact Sheet, which used fasting glucose data to estimate undiagnosed diabetes and prediabetes, the 2011 National Diabetes Fact Sheet uses both fasting glucose and A1C levels to derive estimates for undiagnosed diabetes and prediabetes. These tests were chosen because they are most frequently used in clinical practice.

Under 20 years of age

* 215,000, or 0.26% of all people in this age group have diabetes

* About 1 in every 400 children and adolescents has type 1 diabetes

Age 20 years or older

* 25.6 million, or 11.3% of all people in this age group have diabetes

Age 65 years or older

* 10.9 million, or 26.9% of all people in this age group have diabetes

Men

* 13.0 million, or 11.8% of all men aged 20 years or older have diabetes

Women

* 12.6 million, or 10.8% of all women aged 20 years or older have diabetes

Race and ethnic differences in prevalence of diagnosed diabetes

After adjusting for population age differences, 2007-2009 national survey data for people diagnosed with diabetes, aged 20 years or older include the following prevalence by race/ethnicity:

* 7.1% of non-Hispanic whites

* 8.4% of Asian Americans

* 12.6% of non-Hispanic blacks

* 11.8% of Hispanics

Among Hispanics rates were:

* 7.6% for Cubans

* 13.3% for Mexican Americans

* 13.8% for Puerto Ricans.

Morbidity and Mortality

* In 2007, diabetes was listed as the underlying cause on 71,382 death certificates and was listed as a contributing factor on an additional 160,022 death certificates. This means that diabetes contributed to a total of 231,404 deaths.

Complications

Heart disease and stroke

* In 2004, heart disease was noted on 68% of diabetes-related death certificates among people aged 65 years or older.

* In 2004, stroke was noted on 16% of diabetes-related death certificates among people aged 65 years or older.

* Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.

* The risk for stroke is 2 to 4 times higher among people with diabetes.

High blood pressure

* In 2005-2008, of adults aged 20 years or older with self-reported diabetes, 67% had blood pressure greater than or equal to 140/90 mmHg or used prescription medications for hypertension.

Blindness

* Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years.

* In 2005-2008, 4.2 million (28.5%) people with diabetes aged 40 years or older had diabetic retinopathy, and of these, almost 0.7 million (4.4% of those with diabetes) had advanced diabetic retinopathy that could lead to severe vision loss.

Kidney disease

* Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2008.

* In 2008, 48,374 people with diabetes began treatment for end-stage kidney disease in the United States.

* In 2008, a total of 202,290 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States.

Nervous system disease (Neuropathy)

* About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage.

Amputation

* More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.

* In 2006, about 65,700 nontraumatic lower-limb amputations were performed in people with diabetes.

Cost of Diabetes

* $174 billion: Total costs of diagnosed diabetes in the United States in 2007

* $116 billion for direct medical costs

* $58 billion for indirect costs (disability, work loss, premature mortality)

After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes.

Factoring in the additional costs of undiagnosed diabetes, prediabetes, and gestational diabetes brings the total cost of diabetes in the United States in 2007 to $218 billion.

* $18 billion for people with undiagnosed diabetes

* $25 billion for American adults with prediabetes

* $623 million for gestational diabetes

These statistics and additional information can be found in the National Diabetes Fact Sheet, 2011, the most recent comprehensive assessment of the impact of diabetes in the United States, jointly produced by the CDC, NIH, ADA, and other organizations.

Check and Correct: Controlling Blood Glucose

Blood glucose monitoring is the main tool you have to check your diabetes control. This check tells you your blood glucose level at any one time. Keeping a log of your results is vital. When you bring this record to your health care provider, you have a good picture of your body's response to your diabetes care plan.

Who should check?

The American Diabetes Association recommends blood glucose checks if you have diabetes and are:

* taking insulin or diabetes pills

* on intensive insulin therapy

* pregnant

* having a hard time controlling your blood glucose levels

* having severe low blood glucose levels or ketones from high blood glucose levels

* having low blood glucose levels without the usual warning signs

How do I check?

1. After washing your hands, insert a test strip into your meter.

2. Use your lancing device on the side of your fingertip to get a drop of blood.

3. Gently squeeze or massage your finger until a drop of blood forms. (Required sample sizes vary by meter.)

4. Touch and hold the edge of the test strip to the drop of blood, and wait for the result.

5. Your blood glucose level will appear on the meter's display.

Note: All meters are slightly different, so always refer to your user's manual for specific instructions.

Other tips for checking:

* With some meters, you can also use your forearm, thigh or fleshy part of your hand.

* There are spring-loaded lancing devices that make sticking yourself less painful.

* If you use your fingertip, stick the side of your fingertip by your fingernail to avoid having sore spots on the frequently used part of your finger.

What are the typical ranges?

Here are the blood glucose ranges for adults with diabetes:

Glycemic control A1C less than 7.0%

Preprandial plasma glucose (before a meal) 70–130 mg/dl (5.0–7.2 mmol/l)

Postprandial plasma glucose (after a meal) less than 180 mg/dl (less than 10.0 mmol/l)

Blood pressure less than 130/80 mmHg

Lipids LDL less than 100 mg/dl (less than 2.6 mmol/l)

Triglycerides less than 150 mg/dl (less than 1.7 mmol/l)

HDL greater than 40 mg/dl (greater than 1.1 mmol/l)

What do my results mean?

When you finish the blood glucose check, write down your results and review them to see how food, activity and stress affect your blood glucose. Take a close look at your blood glucose record to see if your level is too high or too low several days in a row at about the same time. If the same thing keeps happening, it might be time to change your plan. Work with your doctor or diabetes educator to learn what your results mean for you. This takes time. Ask your doctor or nurse if you should report results out of a certain range at once by phone.

Keep in mind that blood glucose results often trigger strong feelings. Blood glucose numbers can leave you upset, confused, frustrated, angry, or down. It's easy to use the numbers to judge yourself. Remind yourself that your blood glucose level is a way to track how well your diabetes care plan is working. It is not a judgment of you as a person. The results may show you need a change in your diabetes plan.

What about urine checks for glucose?

Urine checks for glucose are not as accurate as blood glucose checks and should only be used when blood testing is impossible. Urine checks for ketones, however, is important when your diabetes is out of control or when you are sick. Everyone with diabetes should know how to check urine for ketones.

Information provided courtesy of the American Diabetes Association

Strive for 6.5: Hemoglobin A1C

* The A1C test measures your average blood glucose control for the past 2 to 3 months.

* It is determined by measuring the percentage of glycated hemoglobin, or HbA1c, in the blood.

* Check your A1C twice year at a minimum, or more frequently when necessary.

* It does not replace daily self-testing of blood glucose.

Checking your blood glucose at home with a meter tells you what your blood sugar level is at any one time, but suppose you want to know how you're doing overall. The A1C test gives you a picture of your average blood glucose control for the past 2 to 3 months. The results give you a good idea of how well your diabetes treatment plan is working.

In some ways, the A1C test is like a baseball player's season batting average, it tells you about a person's overall success. Neither a single day's blood test results nor a single game's batting record gives the same big picture. You may also be interested in our book, 50 Things You Need to Know About Diabetes.

How does it help diabetes control?

These are some ways the A1C test can help you manage your diabetes:

* Confirm self-testing results or blood test results by the doctor.

* Judge whether a treatment plan is working.

* Show you how healthy choices can make a difference in diabetes control.

Here are two real-life scenarios of how the information from your A1C test can help:

Type 2 Scenario

Bob D., age 49, has type 2 diabetes. For the past seven years, he and his doctor have worked to control his blood sugar levels with diet and diabetes pills. Recently, Bob's control has been getting worse, so his doctor said that Bob might have to start insulin shots. But first, they agreed that Bob would try an exercise program to improve control.

After 3 months of sticking to his exercise plan, Bob returned to the doctor to check his blood sugar. It was near the normal range, but the doctor knew a single blood test only showed Bob's control at that time. It didn't say much about Bob's overall blood sugar control.

The doctor sent a sample of Bob's blood to the lab for an A1C test to learn how well Bob's blood sugar had been controlled, on average, for the past few months. The A1C test showed that Bob's control had improved. With the A1C results, Bob and his doctor had proof that the exercise program was working. The test results also helped Bob know that he could make a difference in his blood sugar control.

Type 1 Scenario

Nine-year-old Lisa J. and her parents were proud that she could do her own insulin shots and urine tests. Her doctor advised her to begin a routine of two shots a day and regular blood glucose checks.

Lisa kept records of all her test results. Most were close to the ideal range. But at her next checkup, the doctor checked her blood and found her blood sugar level was high. The doctor sent a sample of Lisa's blood for an A1C test. The results showed that Lisa's blood glucose control had in fact been poor for the last few months.

Lisa's doctor asked Lisa to do a blood sugar check. To the doctor's surprise, Lisa turned on the timer of her meter before pricking her finger and putting the blood drop on the test strip. The doctor explained to Lisa and her parents that the way Lisa was testing was probably causing the blood sugar test errors.

With time, and more accurate blood sugar results, Lisa and her parents got better at using her results to keep food, insulin, and exercise in balance. At later checkups, her blood sugar records and the A1C test results showed good news about her control.

How does it work?

Hemoglobin, a protein that links up with sugars such as glucose, is found inside red blood cells. Its job is to carry oxygen from the lungs to all the cells of the body. When diabetes is uncontrolled, you end up with too much glucose in the bloodstream. This extra glucose enters your red blood cells and links up (or glycates) with molecules of hemoglobin. The more excess glucose in your blood, the more hemoglobin gets glycated. By measuring the percentage of A1C in the blood, you get an overview of your average blood glucose control for the past few months.

How does the A1C test look backward?

Suppose your blood sugar was high last week. What happened? More glucose hooked up (glycated) with your hemoglobin. This week, your blood glucose is back under control. Still, your red blood cells carry the "memory" of last week's high blood glucose in the form of more A1C.

This record changes as old red blood cells in your body die and new red blood cells (with fresh hemoglobin) replace them. The amount of A1C in your blood reflects blood sugar control for the past 120 days, or the lifespan of a red blood cell.

In a person who does not have diabetes, about 5% of all hemoglobin is glycated. For someone with diabetes and high blood glucose levels, the A1C level is higher than normal. How high the A1C level rises depends on what the average blood glucose level was during the past weeks and months. Levels can range from normal to as high as 25% if diabetes is badly out of control for a long time.

You should have had your A1C level measured when your diabetes was diagnosed or when treatment for diabetes was started. To watch your overall glucose control, your doctor should measure your A1C level at least twice a year -- minimum. There are times when you need to have your A1C level tested about every 3 months. If you change diabetes treatment, such as start a new medicine, or if you are not meeting your blood glucose goals, you and your doctor will want to keep a closer eye on your control.

What are the limitations?

Although the A1C test is an important tool, it can't replace daily self-testing of blood glucose. A1C tests don't measure your day-to-day control. You can't adjust your insulin on the basis of your A1C tests. That's why your blood sugar checks and your log of results are so important to staying in effective control.

Also, different labs measure A1C levels in different ways. If you sent one sample of your blood to four different labs, you might get back four different test results.

For example, an 8 at one lab might mean that blood glucose levels have been in the near-normal range. At a second lab, a 9 might be a sign that, on average, blood glucose was high. This doesn't mean that any of the results are wrong. It does mean that what your results show depends on the way the lab does the test.

Talk to your doctor about your A1C test results. Know that if you change doctors or your doctor changes labs, your test numbers may need to be "read" differently.

The A1C test alone is not enough to measure good blood sugar control. But it is a good resource to use along with your daily blood sugar checks, to work for the best possible control.

Diabetes and Athletics

Section currently being update. Please check back soon!

TT1 Diabetes Sports Research Institute

Each and everyday the athletes of Team Type 1 train and race while also managing the many variables of blood sugar regulation. The daily task of maximizing athletic performance by properly managing blood sugar is a science that Team Type 1 athletes work very hard to control. After years of success in athletics, and with hundreds of years of combined diabetes and exercise experience, Team Type 1 has become the resource for information related to diabetes and exercise.

In 2011, Team Type 1 is taking diabetes and exercise research to the next level, to give those with diabetes worldwide the tools to safely and effectively exercise while managing the many variables of diabetes.

The Science Advisory Board in San Diego, lead by Dr. Juan Frias will work with Team Type 1 athletes during training and racing to further develop the data necessary to give the diabetic athlete the information to make exercise safe, fun and effective, with a decreased chance of unwanted high and low blood glucose readings.

Please signup for the Team Type 1 Newsletter for updates on new research studies being conducted at the TT1 Diabetes Sports Research Institute.

The Fight for Life: Children of Rwanda

In Rwanda, many children and adolescents with diabetes die very quickly. Other young people struggle to survive with insufficient access to insulin and without access to monitoring supplies or trained diabetes healthcare providers. Unable to control their blood glucose, they develop complications early in life. In low-income countries, it is not uncommon to find youths and young adults with devastating complications such as eye damage and kidney failure. For these young people, the years spent developing complications are desperately unpleasant and unhappy.

Throughout 2011, you and Team Type 1 can make a difference in the lives of the children of Rwanda by providing diabetes test strips.

Your donation of excess, unused and unopened test strips will allow the children of Rwanda to better manage their diabetes condition and dramatically improve their lives.

DONATE UNUSED TEST STRIPS TODAY!

To donate your excess, unused test strips, or financially support the Rwanda Mission, please complete the following steps:

1) Download and complete the Rwanda Test Strip Donation Form

2) Specify the quantity of test strips that you will donate or Rwanda Financial Donation Information

3) Package and ship your donated test strips to the address specified on the Donation Form

Monetary Donations:

To support Team Type 1 in their continued efforts to provide inspiration to people living with diabetes worldwide, and to support the teams’ efforts in Rwanda, you may Make a Tax-Deductible Donation to the Team Type 1 Charitable Organization.

Diabetes Resources

Type 1 Diabetes TrialNet

Does someone in your family have diabetes? Find out if others in your family are at risk.

The goal of TrialNet is to perform intervention studies to preserve insulin-producing cells in individuals at risk for type 1 diabetes and in those with new onset type 1 diabetes. TrialNet will focus on identifying individuals "at risk" for developing type 1 diabetes. Risk is based on having autoantibodies or other markers and results of certain tests. These tests include Oral and Intravenous Glucose Tolerance Tests.

TrialNet is screening relatives of people with type 1 diabetes to find out if these family members are "at risk" for developing type 1 diabetes. Screening involves a simple blood test from your arm to look for diabetes-related autoantibodies that may appear years before type 1 diabetes develops.

Relatives of people with type 1 diabetes have about a 3 to 4 percent chance of having autoantibodies in their blood associated with type 1 diabetes.

The following relatives may be screened at no charge to determine their risk:

* relatives between 1 and 45 years of age who have a sibling, child, or parent with type 1 diabetes

* relatives between 1 and 20 years of age who have cousin, aunt, uncle, niece, nephew, half sibling or grandparent with type 1 diabetes

In general, your relative may have type 1 diabetes if it developed before age 40 and required insulin injections within a year of diagnosis.

Natural History Studies are being done to learn more about what causes type 1 diabetes and to find out what might predict the development of the disease. These studies provide close monitoring to individuals "at risk" for developing type 1 diabetes. Individuals at greater risk may be offered an opportunity to participate in a prevention study.

American Diabetes Association

The American Diabetes Association's mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes.

Juvenile Diabetes Research Foundation

JDRF is a leader in setting the agenda for diabetes research worldwide, and is the largest charitable funder of and advocate for type 1 diabetes research. The mission of JDRF is to find a cure for diabetes and its complications through the support of research.

Diabetes Blogs

A Consequence of Hypoglycemia

A Sweet Life

Amazing Grace

Annetics

Bee Musings

Bitter Sweet

BlahBlah Bklyn

Check Diabetes

Chidren With Diabetes

Chronic Babe

Close Concerns

Dia-Beat-This

Diabetesaliciousness

Diabetic Queen

D-Blog

Diabetes in Control

Diabetes in Spain

Diabetes Daily

Diabetes Mine

Diabetes Outside

Diabetes Self-Management

Diabetes Stories

Diabetes Sweeties

DiabetesDaily

DiabetesHealth

DiabetesNewsHound

Diabetic Iz Me

Diabetic-Digest

Divabetic

DLife

D-Mom

Don't Fear Diabetes

Dorkabetic

Dr. Jeckyll and Mrs. Low

Eating Soulfully

Embrace Diabetes

Every Day Every Hour Every Minute

FoodFoodBodyBody

Hope Warshaw

Houston We Have a Problem

I Run on Insulin

Joslin.org

Lemondade Life

Living in Progress

My 2 Sweet Babies

Naturally Sweet

Ninjabetic

Pump Runner (Marcus Grimm Team Type 1 Running Team)

Rep The Betes

Science Daily

Scott's Diabetes

Silver Lined

Six Until Me

Stick it to Diabetes

Sugar Free Aloha

Sweet Sixteen Diabetes!

Sweet to the Soul

Tales of Rachel

The Betes Now

The Butter Compartment

The Diabetes Club

The D-Log Cabin

The Incurable Runner

Transforming Diabetes

Trials and Tribulations of Being a Type 1 Diabetic

Trying To Be Human

Tudiabetes

Type 1 Rider

Typical Type 1

Your Diabetes May Vary

Diabetes and Eyecare

Most diabetes-related blindness can be prevented with routine eyecare. When was your last comprehensive eye exam? If you can’t remember, it’s time to call your eye doctor.

What do your eyes say about you?

Eye exams are an important part of overall healthcare for everyone. Your eyes are the only places on your body that provide a clear view of your blood vessels, which can tell a lot about your overall health. In addition to eye conditions like glaucoma, your eye doctor can see signs of health conditions like high blood pressure and high cholesterol. Eyecare providers can often even see signs of diabetes before a person is aware he or she has the disease.

Diabetes and Your Eyes

Since you won’t always experience symptoms of diabetes related to the eyes, regular eye exams are crucial. In fact, if you wait until you begin to have problems with your vision, damage may have already occurred. An annual dilated eye exam is especially important because it gives your eye doctor a better view inside your eyes to look for vision problems related to diabetes, like diabetic retinopathy, as well as other health conditions.

In addition to an eye exam, here are some things you can do to keep your eyes healthy:

Make sure your A1C levels are under good control. If your A1C levels are elevated for a long period of time, you could begin to experience some issues with your eye health.

Watch your blood pressure. High blood pressure can cause damage to your eyes and creates additional problems with diabetes.

Don’t smoke. Smoking is harmful to your eyes and increases your risk for diabetic retinopathy.

Visit VSP® Vision Care’s Diabetes Discovery Center to learn more about diabetes and eyecare, watch informative videos, or to find an eye doctor near you.

Team Type 1 and Eyecare

VSP Vision Care is the proud sponsor and exclusive provider of Team Type 1’s eyecare and eyewear. As athletes with diabetes, members of Team Type 1 get regular eye exams at one of VSP’s 27,000 doctors throughout the United States.

Team Type 1 members also wear Nike Vision sunglasses to protect their eyes from harmful UV radiation as well as dirt and debris. Their glasses feature interchangeable lenses to enable the riders and runners to have the best lenses for the appropriate light and weather conditions.

When should you have an eye exam?

Eye exams are an important part of overall healthcare for your entire family, from children to grandparents, and everyone in between. In general, everyone—not just those who wear glasses—should have a comprehensive eye exam every year to make sure their eyes are healthy. Visit VSP.com for more information.

Talk with your eye doctor and physician to determine how frequently you should have your eyes examined if you have diabetes, as it may be more frequently than annually.

For more eyecare information, follow VSP Vision Care:

Twitter - @VSPVisionCare

Facebook – VSPVisionCare

Blog – VSPBlog.com