TAKE CHARGE OF YOUR HEALTH Type 1 Diabetes Patients with this disease must take insulin every day because some or all of the insulin-producing cells in the pancreas are destroyed. Type 1 diabetes is an autoimmune disease, which means the immune system attacks the body's own tissues.     Some people may be "genetically programmed" to develop this disease, and some may have it triggered by a viral infection (eg, rubella, mumps) or food (eg, cow's milk). Type 1 diabetes usually starts to develop before age 35; in the US, the peak age for diagnosis is around 14 years (it was formerly called juvenile diabetes). Symptoms include intense thirst, frequent urination, weight loss, weakness, tiredness, and/or blurry vision. Like type 2 diabetes, this condition affects all systems of the body. Diabetes and Weight Loss Fat changes your body's response to insulin, causing it to become more resistant to the hormone's effects. Losing weight helps to reverse this process. Even losing just 10 to 20 pounds can lower your blood glucose level as well as your blood pressure and cholesterol. Supported by an unrestricted educational grant from Pfizer Inc

Type 2 Diabetes: Hazardous to Your Cardiovascular Health Diabetes is a disease in which the body does not properly process glucose (sugar) in the blood. This process provides energy for the body's cells. Normally, glucose enters these cells with help from the hormone insulin, which is produced in the pancreas. If the production or action of insulin is disrupted, glucose builds up in the bloodstream, leading to hyperglycemia (high blood sugar).     According to the American Diabetes Association, there are 17 million people with diabetes in the United States; however, 5.9 million of them are unaware that they have this disorder. Type 2 diabetes affects 90% to 95% of persons with diabetes. This disease occurs when the pancreas produces some, but not enough, insulin; or when the body doesn't properly use the insulin it has (known as insulin resistance). In contrast, type 1 diabetes affects 5% to 10% of persons with diabetes. Here, the body's immune system attacks and destroys insulin-producing cells in the pancreas. (See column at left.) Risk Factors Some factors that can put you at increased risk for developing type 2 diabetes are: age (if you are older than 45 years); family history of diabetes; overweight; inactivity; and/or being of African-American, Hispanic, or Native-American descent. Symptoms, Diagnosis, Treatment Type 2 diabetes develops slowly. The first signs are usually excessive thirst and frequent urination. Some people also experience weight gain or loss; blurred vision; fatigue; frequent skin, mouth, or bladder infections; slow-healing sores; and/or leg pain or tingling/numbness in hands or feet.     Diabetes is usually detected with a blood test. Normal fasting (on an empty stomach) blood glucose levels are less than 110 milligrams per deciliter (mg/dL). If your fasting blood glucose level is 126 mg/dL or more on 2 or more different days, then you will likely be diagnosed as having diabetes. Your doctor will then want to measure your blood glucose after eating or drinking.    The goal of treatment is to bring your blood glucose level under control, which means that you must measure it regularly (this may be as infrequently as twice a week or as often as four times a day). The first step in treatment is to lose weight through diet and exercise. People with diabetes have an increased risk of developing atherosclerosis (hardening of the arteries) and heart disease; therefore, they must be especially careful to avoid foods with too much fat or cholesterol. Regular aerobic exercise (for 30 minutes on most days of the week) is also important. If diet and exercise are insufficient to control your blood sugar, then your doctor will prescribe medication. Drug Therapy Here are medications that your doctor may prescribe in addition to lifestyle modifications: Sulfonylureas help the pancreas release more insulin. These include: Glucotrol®, Diabeta®, Amaryl®. Meglitinides work in a similar manner to sulfonylureas, but have a shorter duration of action. These include: Prandin®, Starlix®. Biguanides inhibit production/release of glucose by the liver. Glucophage® is the only drug in this class in the US. Alpha-glucosidase inhibitors decrease blood glucose by inhibiting the breakdown of carbohydrates into simple sugars. These include: Precose®, Glyset®. Thiazolidinediones sensitize body tissue to insulin. These include: Actos®, Avandia®. Insulin is administered under the skin with a syringe, pen injector, or pump device.