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DIABETES DEFINITIONS: THE $5 WORDS

by Ann S. Williams, RN, MSN, CDE

This article appeared in Voice of the Diabetic, Volume 20, No. 2, April
2005 edition, published by the Diabetes Action Network of the National
Federation of the Blind.

This month's column covers definitions of words and phrases used
to talk about diabetes and diabetes care. I'm particularly going to cover
words and phrases you're likely to hear from your doctor or diabetes
educator. I'll organize the words into subject areas: words about diabetes
diagnosis; words about lab tests; words about high and low blood sugar;
words about long-term diabetes complications; and words about controlling
diabetes. In each section, the words are in alphabetical order.

Words About Diabetes Diagnosis

Beta cells, or the Islets of Langerhans: The cells in the pancreas that
make insulin. They are called Islets of Langerhans because a doctor
named Langerhans discovered them, and he thought they looked like little
islands in the pancreas.

Diabetes mellitus: This is what we usually call just plain "diabetes" -- a
disease in which the dissolved sugar in the blood is high. It means,
literally, "sweet diabetes."

Diabetes insipidus: This is much less common than diabetes mellitus. It
means literally "bland diabetes." When a person has diabetes insipidus,
there is an imbalance of hormones that causes the person to make a lot of
very dilute urine. It's a completely different condition than diabetes
mellitus, and has nothing to do with blood sugar.

Gestational diabetes: A type of diabetes that develops during pregnancy.
It usually goes away after the baby is born. But a mother who has had
gestational diabetes is much more likely to develop type 2 diabetes later in
life. Gestational diabetes is managed with diet and exercise, and
sometimes insulin.

Insulin: A hormone naturally made by the body. It helps all the cells of
the body to use glucose, or sugar, for energy.

Insulin resistance: The inability of the body to use insulin efficiently.
When a person has insulin resistance, it takes a lot more insulin to control
blood sugar than when a person does not have insulin resistance. Insulin
resistance often happens in people who are overweight, or in people who
don't get much exercise, or both. Taking a medication, such as steroids,
can increase insulin resistance.

Pre-Diabetes: A condition in which a person has a higher blood sugar than
normal, but not high enough to be diagnosed with diabetes. By definition,
the fasting blood sugar is higher than 100, and lower than 126. A person
with pre-diabetes is at risk for developing diabetes, and also for heart
attack and stroke.

Type 1 diabetes: Diabetes in which the person does not make any
insulin, and must inject insulin to live. This type used to be called juvenile
diabetes, insulin dependent diabetes, and type I diabetes. Most often
develops in children or young adults, but can happen at any time of life.

Type 2 diabetes: Diabetes in which the person still makes some insulin.
Either the person does not use the insulin efficiently (insulin resistance), or
the person does not make enough insulin (insulin deficiency), or there is
some combination of these. This type used to be called adult onset
diabetes, non-insulin dependent diabetes, and type II diabetes. Most often
it develops in adults who are aged 40 and older, but it can develop in
younger adults, teenagers, and even some children.

"A touch of sugar," "borderline" diabetes, and "the less serious
kind:" These types of diabetes do not really exist. People sometimes use
these words to talk about diabetes that is not treated with insulin.
However, there are no real definitions for these words. Using these words
makes it sound as if the person's diabetes is not very serious. But a
condition that, out of control, can cause a person to have an amputation,
lose his or her eyesight, cause the kidneys to fail, and cause a heart attack
or stroke really should not be called "less serious." ALL diabetes should be
taken seriously, whether a person uses insulin or not.

Words About Lab Tests

A1C (also called hemoglobin A1C, glycosylated hemoglobin): This lab
test is important because it measures the average blood glucose over
about the last three months. It shows how much glucose is stuck on to the
red blood cells in a person's blood. The higher the blood glucose
percentage, the more sticks to the red cells. The longer the blood glucose
is high, the more sticks to the red cells.

Albuminuria: A condition in which the urine contains more than a normal
amount of albumin. Albumin is a particular kind of protein. Albuminuria
can be a sign of kidney disease.

Blood glucose: The amount of sugar dissolved in the blood. In the
United States, it is usually given in units of milligrams per deciliter (mg/dl).

Cholesterol: A type of waxy fat made in the liver. It is also present in
some foods.

Fasting glucose: The amount of dissolved sugar present in the blood
after the person has not had anything with calories in it to eat or drink for
eight hours or more.

HDL Cholesterol: The initials HDL stand for high density lipoprotein. This
is a fat in the blood that takes extra cholesterol from the blood to the liver,
to remove it from the body. It's often called the "good" cholesterol, the kind
for which you want high levels. You can remember which it is because it
begins with "H" for high levels.

Hypercholesterolemia: High levels of cholesterol in the blood.

Hypertension: High blood pressure. Many people think the word
hypertension has something to do with being emotionally tense. It's true
that emotional tension can sometimes raise a person's blood pressure, but
the word hypertension does NOT mean emotional tension; it simply means
high blood pressure.

LDL cholesterol: The initials LDL stand for low density lipoprotein. This
type of cholesterol takes fat around the body to where it is needed, and
also deposits fat on artery walls. It's often called "bad" cholesterol, the
kind for which you want low levels. You can remember which it is because
it begins with "L" for low levels.

Lipid panel or lipid profile: A lab test that measures total cholesterol,
triglycerides, HDL cholesterol, and LDL cholesterol. It's important because
it is one way of telling a person's risk for heart disease.

Proteinuria: The presence of protein in the urine. It can be an early sign
of kidney disease.

Triglycerides: The form in which fat is stored in the body. When diabetes
is out of control, there are often high levels of this type of fat in the blood.
It's a risk factor for heart attack and stroke.

Words About High And Low Blood Sugar, And Other Related
Conditions

Hyperglycemia: A high level of glucose (dissolved sugar) in the blood.
Fasting hyperglycemia is a high level of glucose in the blood after a person
hasn't eaten for eight hours. Postprandial hyperglycemia is a high level of
glucose in the blood one to two hours after the person last ate.

Hypoglycemia: A low level of glucose (dissolved sugar) in the blood,
usually below 70 mg/dl, although some people have symptoms of
hypoglycemia at higher levels. Also called insulin reaction.

Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS): a
condition that starts when the blood glucose is high over a long time in
someone with type 2 diabetes. The person does not have any ketones in
the blood, because there is still some insulin in the system. But the person
has very high blood sugar (in the 800s or even higher), has lost a lot of
fluid, and is dehydrated. Therefore, the blood is very concentrated. This is
a medical emergency, and can be fatal. The person should go to a
hospital for treatment.

Ketoacidosis, ketosis, diabetic ketoacidosis, or DKA: A condition that
starts when there is very little insulin in the blood. The blood sugar gets
very high. Because the body cannot use glucose for energy, it starts to
break down fat at a rapid rate. One of the waste products produced when
fat is broken down rapidly is a high level of ketones in the blood and urine.
Symptoms include nausea, vomiting, stomach pain, fruity breath, rapid
breathing, and ketones in the urine. High levels of ketones can be toxic.
Ketoacidosis is a medical emergency. If it's caught early, some doctors will
treat some people at home. But for most people, it's best to be treated in a
hospital.

Ketonuria: Ketones in the urine. This happens when a person has
ketoacidosis. You cannot see the ketones, but can test for them by
dipping a ketone test strip in the stream of urine, waiting for the correct
amount of time, and comparing the color to a color chart on the bottle. As
of this writing, there is no adaptive equipment that allows a person who
cannot see colors to test for ketones independently.

Words About Long-Term Diabetes Complications

Amputation: The surgical removal of part or all of a limb. BK means
below the knee; AK means above the knee.

Cardiac ischemia: A condition in which the muscle of the heart is not
getting enough blood, usually because of blocked blood vessels. This can
cause a severe pain, known as angina, although sometimes a person does
not feel it at all.

Cataract: A clouding of the lens of the eye.

Congestive heart failure: A condition in which the heart does not pump
blood efficiently. The pumping is weak enough that the blood does not
return to the heart fully. The person has fluid building up in body,
especially in the legs and the lungs.

Diabetic retinopathy: A diabetic eye disease in which the diabetes has
produced damage to the small blood vessels in the retina. The retina is
the part of the eye that receives light and makes it possible for a person to
see. Damage to the retina can cause vision loss.

Gangrene: The death of body tissue. It's most often caused by infection
and lack of blood flow. It can lead to amputation.

Glaucoma: An increase in the pressure of the fluid inside the eyeball. It
can be very painful. If it is not controlled, it can lead to vision loss.

Neuropathy, peripheral and autonomic: Damage to the nerves.
Peripheral neuropathy is damage to the nerves in the limbs. Usually it
starts in the toes, feet and hands, and it can progress up the legs and
arms. Autonomic neuropathy is damage to the nerves that go to the body
organs: the stomach, intestines, heart, lungs, bladder, or genitals.

Renal disease and renal failure: Kidney disease, and kidney failure.

Sudden cardiac arrest: Sudden stopping of the heart. The person might
not have had any known heart disease. The cause can be a loss of blood
supply to the heart from blockage. Or it can be from rapid or irregular
heartbeat.

Stroke: A condition caused by damage to the blood vessels that serve the
brain. Some people have started calling stroke a brain attack, because it is
so much like a heart attack. Stroke can be caused by blockage of a blood
vessel, or by bursting and bleeding from a blood vessel. Either way, a part
of the brain is not getting the oxygen and the glucose it needs to work
properly. Damage from a stroke might cause a person to lose the ability to
speak, or to understand words, or to move one side or part of the body.

Words About Controlling Diabetes

Carbohydrates: One of the main nutrients in foods. All carbohydrates are
either starches or sugars when they are in foods. Starches are just long
chains of sugars, a little like a long train of railroad cars. When they are
digested, it's as if the cars of the train are separated. After they are
digested, they all go into the blood as sugars.

Carbohydrate to insulin ratio: The amount of carbohydrate covered by
one unit of insulin. This number varies from person to person. Many
people with type 1 diabetes find that 15 grams of carbohydrate are covered
by 1 unit of insulin, so the carbohydrate to insulin ratio is 15/1. But some
people are more sensitive. For some people, 20 grams of carbohydrate
are covered by 1 unit of insulin, so their carbohydrate to insulin ratio is
20/1. And some people are less sensitive, and may have a carbohydrate
to insulin ratio of 10/1, or 7/1.

Correction ratio: The blood glucose drop a given person can expect from
1 unit of insulin. Many people with type 1 diabetes find their blood glucose
drops 50 points for each 1 unit of insulin, so the correction ratio is 50/1. A
more sensitive person might have a ration of 60/1, and a less sensitive
person might have a ratio of 30/1 or 25/1.

Euglycemia: A normal level of glucose in the blood.

Glycemic index: A way of describing the effect of types of carbohydrate
on blood glucose, by ranking standard amounts of the foods in comparison
to a standard reference food. For example, one popular glycemic index
compares how much certain foods raise the blood sugar compared to a set
amount of glucose. The glycemic index is more popular outside the U.S.
than it is inside the U.S. However, some people in the U.S. really like
using it.

Are there other words you need to have defined?

I know many people feel embarrassed to ask health care professionals
just what they mean by a particular word; so if there is something I don't
cover that you want to know about, please contact the me, c/o Ed Bryant,
Editor, Voice of the Diabetic, 1412 I-70 Drive SW, Suite C, Columbia, MO
65203; telephone: (573) 875-8911; e-mail: [email protected]. I'll answer
your question in my next column.