Diabetes Definitions

Pre-diabetes: As defined by the American Diabetes Association (ADA), a condition of pre-diabetes exists when an individual has glucose levels that do not meet the criteria for a diagnosis of diabetes, but are higher than what is considered normal. Persons with pre-diabetes are at increased risk of developing Type 2 diabetes if they do not change their lifestyle for risk reduction. Laboratory studies to diagnose pre-diabetes include; an A1C of 5.7-6.4% OR a fasting glucose of 100 to 125 mg/dL OR a 2-hour post meal or oral glucose tolerance test where a glucose of 140 to 199 mg/dL is found.

Type 2 Diabetes: The most common type of diabetes. It is often present for many months to years before the diagnosis is made and is often not diagnosed until complications appear. Development of Type 2 diabetes is multifactorial and includes; a genetic predisposition, sedentary lifestyle, obesity, age, a history of gestational diabetes, low HDL, elevated triglycerides, and race/ethnicity. It is the result of insulin resistance or insulin deficiency. Diagnostic criteria, as per the American Diabetes Association includes an A1C of 6.5% or greater, a fasting glucose of 126mg/dL or greater, a 2 hour post meal or oral glucose tolerance test with a finding of 200mg/dL or greater, OR classic symptoms of high glucose or hyperglycemic crisis with a glucose of 200mg/dL or greater. The ADA recommends that in the absence of unequivocal hyperglycemia that the results be confirmed by repeat testing.

Type 1 Diabetes: Is a condition of absolute insulin deficiency due to ?-cell destruction (previously termed Juvenile Diabetes as it was once believed to occur only in children). Individuals with Type 1 Diabetes require insulin injections to control their glucose. They may also benefit from some oral medications to control glucose levels but insulin injections are a MUST.

Gestational Diabetes: The type of diabetes that occurs during pregnancy and presents an increased health risk for the mother and baby. Typically, a woman is screened for diabetes at the first office visit and then again between the 24th and 28th week. If the glucose is abnormal further studies are ordered such as a glucose tolerance test. Glucose control is managed very differently during pregnancy so it is important that you work closely with your health care team during this time.

Diabetes with Pregnancy: Women with Type 1 diabetes as well as Type 2 diabetes can become pregnant. The pregnancy is considered a high-risk pregnancy and strict adherence to medical office visits, diet, exercise, medications and glucose monitoring must be achieved. Before entering a pregnancy, a woman with pre-existing Type 1 or Type 2 diabetes would ideally present to her provider for pre-pregnancy counseling and have an A1C that is well controlled.

Diabetes Self-Management Education/Training (DSME/T): As per the American Association of Diabetes Educators (DSME/T) is education and training to help individuals with diabetes learn how to manage their disease and be as healthy as possible. It emphasizes seven self-care behaviors that are important to focus on to be healthy and fully enjoy life. The goal of diabetes education is to help people with diabetes practice these behaviors every day. This can be difficult but it does work, by helping lower blood sugar (glucose), blood pressure and cholesterol. Most people with diabetes know self-management is important, but many find it overwhelming. Diabetes education helps by designing a specific plan for each person that includes the tools and support to help make the plan easy to follow.

Medical Nutrition Therapy (MNT), as per the American Academy of Nutrition and Dietetics, is the legal definition of the nutritional diagnostic, therapy and counseling services for the purpose of disease management which are furnished by a registered dietitian or nutritional professional. It is typically an individualized nutrition prescription written around your lifestyle, food preferences, activity level, nutritional needs and glucose control.

INSULIN: A hormone secreted by the B-cells (“Beta” cells are the insulin producing cells found in the pancreas) and released directly into the blood stream for glucose control. Several synthetic versions of insulin are manufactured for injection into the skin and can be used in Type 1, Type 2, gestational, and diabetes in pregnancy.

INSULIN RESISTANCE: A condition that develops as part of a syndrome. This syndrome occurs when a combination of conditions occur such as hypertension, increased abdominal fat, elevated triglycerides, and low HDL. These conditions cause a dysfunction of insulin receptor sites on the cells in the body leading to high post meal glucose and eventually to elevated fasting glucose. It is present even before the criteria for a pre-diabetes diagnosis have been met.

B-cell: “Beta” cells are the insulin-producing cells found in the pancreas.

INSULIN PUMP THERAPY (IPT): A mechanical device produced by several different manufacturers. It is worn externally. A small catheter is placed into the skin and is changed every 3 days by the pump wearer. No surgery is required. Many people can benefit from IPT, especially those having great difficulty controlling their glucose. Information about the different insulin pumps can be found online.

CONTINUOUS GLUCOSE MONITOR SENSOR (CGMS): A device that is placed into the skin to collect data about glucose control. Some devices show the wearer what their glucose reading is while others require that the device be downloaded at the physician’s office. Many people can benefit from CGMS especially those having difficulty controlling their glucose. Information about the different continuous glucose sensors can be found online.

A1C: The marker of diabetes management. It is a lab test that represents the glucose average for the past 90 days. Anyone with diabetes or pre-diabetes should know what their A1C value is and share this with all of your health care providers: eye doctor, dentist, podiatrist (foot doctor) etc.

FASTING GLUCOSE: A blood sugar evaluated after eight hours has passed since ingestion of any caloric food or liquid. It can be performed at the lab or with your home blood glucose monitor.

ORAL GLUCOSE TOLERANCE TEST: This is a lab test that is ordered by your healthcare provider. It requires that you fast overnight and present to the lab where an initial glucose will be evaluated. You will then be required to drink a glucose mixture and your glucose will be tested again in two hours.

2-HOUR POST MEAL: The 2-hour post meal glucose is an important number to know as it identifies how efficiently your pancreas or your diabetes medications are working. It can be used to diagnose the condition of diabetes.

OBESITY: A condition of excess body weight defined by a body mass index (BMI) of 30.0 or greater.

GENETIC PREDISPOSITION: Is an increased likelihood of developing a condition due to a person’s genes. While our genetic composition cannot be changed, our lifestyle and actions can control our destination.

SEDENTARY LIFESTYLE: Is a pattern of doing little or infrequent physical activity for long periods. This increases your risk for heart disease and increases insulin resistance.

AGE: Individuals over the age of 45 are at greater risk of developing Type 2 diabetes and should receive an annual screening.

HDL: High Density Lipoprotein. Part of a lipid panel. Known as “the Happy Housekeeper” as it removes bad fats from the blood stream. The HDL is a number that you would like to be High. A number less than 35 increases the risk of Type 2 Diabetes.

TRIGLYCERIDES: A component of the lipid panel that is a reflection of carbohydrate metabolism. Triglycerides are elevated when the liver cannot process the volume of carbohydrate that is consumed. These are also driven high due to alcohol consumption. Ideally this number would be low. A number greater than 250mg/dL is a risk factor for Type 2 Diabetes. This number responds quickly to diet and exercise although medication may be needed.

RACE/ETHNICITY: Persons of African American, Latino, Native American , Asian American, Pacific Islander decent are genetically predisposed to the development of Type 2 Diabetes.

COMPLICATIONS: Persons with Type 1 and Type 2 Diabetes are at risk of developing complications. This occurs over time and is due to elevations in glucose as well as wide fluctuations in glucose place a stress on the walls of your blood vessels. The process is one of glycosylation which is analogous to oxidation which we know as “rust.” While your arteries are not rusting, when your glucose is elevated or fluctuating, they are becoming irritated. This irritation can lead to problems with the very small blood vessels and lead to problems with your eyes (Diabetic Retinopathy), kidneys (Diabetic Nephropathy), heart (Coronary Artery Disease), and nutrition supply to the nerve endings (Diabetic Neuropathy).