School Guide Teaches ABCs of Diabetes

School-age children with diabetes face unique challenges. They may be vulnerable to serious swings in their blood glucose levels at any time. A newly updated booklet, “Helping the Student with Diabetes Succeed: A Guide for School Personnel,” can help. The guide offers suggestions for parents, teachers, principals and others to ensure the safety of these kids.

Diabetes is one of the most common long-term diseases in school-age children. It affects about 200,000 young people nationwide. Most students with diabetes must carefully monitor and control their blood glucose throughout the day. A severe drop in glucose levels can be life-threatening.

The guide urges parents to notify school officials that a child has diabetes. Parents are encouraged to partner with the child’s health care team to develop a diabetes medical management plan. The guide recommends that parents give permission for medical information to be shared by the school and health care team.

”Unfortunately, the need to manage diabetes doesn’t go away at school,” says Dr. Griffin P. Rodgers, director of NIH’s National Institute of Diabetes and Digestive and Kidney Diseases. “The guide, quite literally, can be a lifesaver.”

To view, download or order a free copy of the guide, go to www.YourDiabetesInfo.org/schoolguide(link is external),

Breastfeeding May Help Health After Gestational Diabetes

A study suggests that breastfeeding may help women with a history of gestational diabetes from later developing type 2 diabetes.

About 5-9% of pregnant women nationwide develop high blood sugar levels even though they didn’t have diabetes before pregnancy. This condition, called gestational diabetes, raises a woman’s risk for type 2 diabetes later in life. Left untreated, type 2 diabetes can cause health problems such as heart disease, stroke, kidney disease, blindness, and amputation.

Past studies found that breastfeeding causes certain changes in the mother’s body that may help protect against type 2 diabetes. However, the connection hadn’t been proven, especially among women who’d had gestational diabetes. An NIH-funded research team at the Kaiser Permanente Division of Research set out to address the question.

The team enrolled more than 1,000 ethnically diverse women who were diagnosed with gestational diabetes. Their lactation intensity and duration were assessed by feeding diaries, in-person exams, phone calls, and questionnaires. Researchers tested blood sugar 6 to 9 weeks after delivery and then annually for 2 years.

During the 2-year follow-up, nearly 12% of the women developed type 2 diabetes. After accounting for differences in age and other risk factors, the researchers estimated that women who exclusively breastfed or mostly breastfed were about half as likely to develop type 2 diabetes as those who didn’t breastfeed.

How long women breastfed also affected their chance of developing type 2 diabetes. Breastfeeding for longer than 2 months lowered the risk of type 2 diabetes by almost half. Breastfeeding beyond 5 months lowered the risk by more than half.

“These findings highlight the importance of prioritizing breastfeeding education and support for women with gestational diabetes as part of early diabetes prevention efforts,” says study lead Dr. Erica P. Gunderson.

Five Lifestyle Factors Lower Diabetes Risk

A new study found that a combination of 5 healthy lifestyle factors may help reduce the chance of developing type 2 diabetes, even if family history puts you at risk for the disease.

People with diabetes have too high levels of glucose, a type of sugar, in their blood. Over time, high levels of glucose can lead to heart disease, stroke, blindness and other problems.

Several lifestyle factors can reduce your risk for type 2 diabetes, the most common form of the disease. A research team led by Dr. Jared Reis of NIH studied 5 factors:

• having a healthy diet,
• keeping an ideal body weight,
• being physically active,
• not smoking, and
• minimizing alcohol use.

The team used data collected in the mid-1990s from more than 200,000 older adults. They then looked to see who had developed diabetes over the next decade.

The analysis showed that the more healthy lifestyle factors adopted, the lower the risk for diabetes. Men with all 5 healthy lifestyle factors had a 72% lower risk for developing diabetes. Women had an 84% lower risk.

A family history of diabetes is strongly linked to type 2 diabetes. But these results show that you may still be able to prevent or delay the disease by leading a healthy lifestyle.

“Not being overweight or obese led to the greatest protection,” Reis says. “However, we found that overweight or obese adults with a greater number of the other healthy lifestyle factors had a lower risk of developing diabetes. This is good news because it suggests that overweight or obese adults can benefit by adopting other healthy lifestyle behaviors.”

Eye disease is one of the most common and debilitating complications of diabetes. NIH especially encourages people with diabetes to take steps to avoid vision loss by having the exam each year.

Diabetes is the leading cause of blindness in adults nationwide. An eye disorder known as diabetic retinopathy arises in about 40% of U.S. adults with diabetes. It occurs when blood vessels of the retina swell and leak fluid. In some cases, blood vessels become blocked and rupture, or new vessels grow on the retina, leading to permanent vision loss.

People with diabetes are also at risk for cataracts, which cause clouding of the eye lens, and glaucoma, which damages the optic nerve.

Comprehensive, dilated eye exams allow eye care professionals to monitor the eye, including the retina, for signs of disease. Diabetic retinopathy usually has no symptoms until vision loss occurs, but annual dilated eye exams can identify signs of it. In fact, about 90% of diabetes-related blindness is preventable through early detection, timely treatment and appropriate follow-up care.

Diabetes Increases in Children and Teens

The study found a rise in the rate of new cases of diabetes in youths under the age of 20.MarkHatfield/iStock/Thinkstock

A recent study found that rates of new cases of diabetes in children and teens rose during 2002 to 2012. The researchers reported increases in the rates of both type 1 and type 2 diabetes.

More than 29 million Americans are living with diabetes. People with diabetes have sugar (glucose) levels that are too high. Over time, high levels of blood glucose can cause many health problems.

In type 1 diabetes, the body does not produce insulin. People with type 1 diabetes need to take insulin every day to stay alive. Type 2 diabetes is caused when the body doesn’t make or use insulin well.

Researchers found that, for each year between 2002 and 2012, the rate of new cases of type 1 diabetes in youths under 20 rose by about 2%. The rate of new cases of type 2 diabetes in youths ages 10 to 19 increased by about 5%. Unlike type 1 diabetes, type 2 is seldom diagnosed in children younger than 10.

The researchers noted that rates of diabetes rose significantly in certain racial and ethnic groups. For type 1 diabetes, the rate of new cases increased in Hispanics, non-Hispanic blacks, and non-Hispanic whites. For type 2 diabetes, the rate of new cases rose in Hispanics, non-Hispanic blacks, Asian Americans/Pacific Islanders, and Native Americans.

The study also detected differences in the rates for male and female youths. For type 1 diabetes, the rate rose more in males. For type 2 diabetes, the rate increased more in females.

“The differences among racial and ethnic groups and between genders raise many questions,” says Dr. Barbara Linder, NIH’s senior advisor for childhood diabetes research. “We need to understand why the increase in rates of diabetes development varies so greatly and is so concentrated in specific racial and ethnic groups.”

NIH-funded studies are now examining what factors may increase the risk of diabetes.

Experimental Therapy Shows Promise for Type 1 Diabetes

People with type 1 diabetes need to closely monitor their blood glucose levels.AndreyPopov/iStock/Thinkstock

Patients with difficult cases of type 1 diabetes were helped by transplants of insulin-producing islet cells. The experimental therapy helped to prevent dangerous drops in blood sugar levels.

People with diabetes have trouble managing and using blood glucose, a sugar that serves as fuel for the body. When blood glucose levels rise, islet cells in the pancreas normally make and secrete hormones such as insulin. Insulin triggers cells to take up sugar from the blood.

In type 1 diabetes, the immune system attacks and destroys these insulin-producing cells. People with type 1 diabetes must regularly measure their blood glucose and use insulin injections to maintain their blood sugar levels.

When blood sugar levels drop too low (hypoglycemia), symptoms like shaking or sweating usually warn people to eat or drink to raise their blood sugar levels. However, many people with type 1 diabetes can’t tell when their blood sugar is too low. This raises their risk for severe hypoglycemia, which can cause seizures, loss of consciousness, and death.

One strategy to treat type 1 diabetes is to transplant pancreatic islets from deceased human donors. To test this experimental procedure, NIH-funded researchers studied 48 people with hard-to-treat type 1 diabetes. Participants received at least one transplant of pancreatic islets.

During the first year after treatment, 88% of participants were free of severe hypoglycemic events, had near-normal control of blood glucose levels, and were able to tell when their blood sugar was low. After 2 years, 71% still had these positive effects. Some people had side effects. Researchers are still monitoring the patients to assess the benefits and risks of this therapy.

“While still experimental, and with risks that must be weighed carefully, the promise of islet transplantation is undeniable and encouraging,” says Dr. Griffin P. Rodgers, director of NIH’s National Institute of Diabetes and Digestive and Kidney Diseases.

Fact Sheet Highlights Diabetes Blood Test

About 7 million Americans today have diabetes but don’t realize it. This puts them at risk for the serious complications that can arise when diabetes is left untreated.

A new fact sheet from NIH describes a blood test called A1C, which can diagnose type 2 diabetes and even prediabetes. Prediabetes raises your risk for developing type 2 diabetes.

You don’t need to fast before taking the A1C test, so it’s more convenient than other glucose tests often used to diagnose diabetes. The A1C test can also help patients with type 1 and type 2 diabetes to monitor their blood sugar (glucose) levels.

The new fact sheet covers a wide range of details about the A1C test, including how the test works, other blood tests for type 2 diabetes and prediabetes, the accuracy of blood tests and more.

4 Steps to Manage Your Diabetes for Life

Each year, 1.7 million Americans, ages 20 and up, are diagnosed with diabetes. People with diabetes have high levels of blood glucose (also called blood sugar). If left undiag­nosed or untreated, diabetes can lead to heart disease, stroke, kidney disease, blindness, and other health problems. That’s why it’s important to manage your diabetes ABCs: A1C (blood glucose), blood pressure, and cholesterol. The 4 steps below are a good start.

Step 1: Learn about diabetes. If you’ve got diabetes, you need to make healthy food choices, move more every day, stay at a healthy weight, and take recommended medicines even when you feel good.

Step 2: Talk to your health care team about how to manage your A1C, blood pressure, and cholesterol. Know your ABC goals, and track your progress.

Step 3: Learn how to live with diabetes. Even if you know the steps you should take to stay healthy, you may have trouble sticking with these steps over time. Work with your health care team to make a plan that will work for you.

Step 4: Get routine care to stay healthy. See your health care team at least twice a year to find and treat any problems early. Once each year, be sure to get a dilated eye exam and a complete foot exam.

Managing Diabetes

New Technologies Can Make It Easier

Your body takes care of countless tasks for you. You might not notice all it’s doing to keep you healthy until something goes wrong.

Diabetes is a serious disease that happens when your body has trouble managing and using blood glucose, a sugar that your body uses as fuel. When you have diabetes, you must actively take on this process yourself. New technologies are being tested to make it easier for you to control diabetes and to help you stay healthy.

More than 100 million Americans are living with diabetes or prediabetes, a condition where blood glucose levels are higher than normal, but not high enough to be considered diabetes. People with diabetes must frequently check their blood glucose (or blood sugar) and take quick action if it gets too high or low. They must also constantly consider how all meals, physical activity, and things like stress will affect their blood glucose.

Types of Diabetes

How people with diabetes manage their blood glucose levels depends, in part, on the type of diabetes they have. The most common are type 1, type 2, and gestational diabetes.

With type 1 diabetes, your body doesn’t make enough of a hormone called insulin. Insulin signals the body’s cells to let glucose inside. The body can’t produce enough insulin because the immune system, your body’s defense against germs and foreign substances, mistakenly attacks and destroys the cells in your pancreas that make insulin.

Type 2 diabetes is the most common. It occurs when either your body’s cells have trouble using insulin or your body doesn’t produce enough insulin to handle the glucose in your blood.

Both types can develop at any age. Type 1 is most often diagnosed in children and young adults, while type 2 shows up most in middle-age and older people. Gestational diabetes occurs only during pregnancy, but increases your chances of developing type 2 later in life.

Diabetes symptoms can vary by type. Some shared symptoms include increased thirst, hunger, and urination. Symptoms of type 1 can start quickly, over a few weeks. Type 2 symptoms tend to develop slowly over years, making them less noticeable.

Blood Glucose Control

Many people with diabetes check their blood glucose with a blood glucose meter. This portable machine measures how much glucose is in the blood. You get a drop of blood by pricking the side of your fingertip with a small, specialized needle. Then you apply the blood to a test strip. The meter shows you how much glucose is in your blood at that moment.

People with type 1 diabetes, and some people with type 2, correct and manage their blood glucose with injections of synthetic insulin. A missed, or miscalculated, dose can lead to serious complications, immediately and over time. Diabetes increases your risk for blindness, heart disease, stroke, kidney failure, and amputation.

“It’s a significant burden to self-test sugar levels several times a day, count carbohydrates with each meal, take into account the impact of physical activity, and then calculate the amount of insulin you need to inject multiple times a day with a syringe or the help of an insulin pump,” explains Dr. Guillermo Arreaza-Rubín, who heads NIH’s Diabetes Technology Program. Any error in this management may lead to life-threatening complications like severe hypoglycemia, which is very low blood glucose.

“Hypoglycemia is one of the main reasons people with type 1 visit hospital emergency rooms every day,” Arreaza-Rubín says. “It happens more frequently during the night and is a major cause of fear and anxiety among people with diabetes and their families.”

Help From Technology

NIH funded-scientists are testing promising technologies to help people better manage diabetes. For example, “artificial pancreas” systems monitor blood glucose levels and provide insulin, or a combination of insulin and another important hormone, automatically. The devices vary in how easy they are to set up and use.

“Our device, called the iLet, is designed to minimize the guesswork and time drain that comes with managing type 1 diabetes,” says Dr. Edward Damiano, a biomedical engineering expert at Boston University who’s co-founded a company to further develop the technology. The device only requires that you type in your body weight to get started. “The system does the heavy lifting of regulating blood glucose, freeing up the user to live a less burdened and more spontaneous life.”

Previous studies have shown that artificial pancreas systems can be safer than the current standard for insulin delivery. Several different devices are now being tested in more people for longer periods of time. Researchers are looking at safety, user-friendliness, the physical and emotional health of the participants, and cost.

Safety is a priority for researchers. “When people with type 1 exercise, their blood glucose can respond in unpredictable and potentially dangerous ways,” explains University of Virginia engineer Dr. Marc Breton. He led a recent study that showed an artificial pancreas system improved glycemic control and reduced hypoglycemia in adolescents with type 1 diabetes as they participated in winter sports, like skiing and snowboarding.

“The artificial pancreas performed very well in an extremely challenging environment,” he says. “Eventually, it may allow people with diabetes the freedom to participate safely in physical activities that they likely avoided in the past.”

One FDA-approved artificial pancreas is already available for people with diabetes. Devices that are more fully automated may become available to the public within the next couple years. Researchers are considering how to use these systems for people with type 2, gestational diabetes, and other conditions involving elevated blood glucose levels.

Other scientists are taking different approaches to replace insulin more effectively. For example, “smart insulins” would become active only when needed. Researchers are also looking for ways to regenerate or replace insulin-producing cells—and to stop the body from attacking them.

“These technologies will help make managing diabetes easier and will help make people who use them healthier,” says Damiano. “I see them as a bridge to a cure for type 1 diabetes.”

While future tools may make it easier to manage your diabetes, you can learn how to manage diabetes with the tools we have now to live a long, healthy life. Medications, glucose monitors, and insulin pumps are all available now to help people with diabetes. If you have diabetes, talk with your health care provider about your options.