and it is believed that it often occurs first, followed by a decline in pancreatic function and insulin production. Type 2 can occur at any age, but is most common in those with one or more risk factors for the disease.
TYPE 2 DIABETES—HOW RISKY IS IT?
Type 2 diabetes accounts for majority of cases of diabetes. In fact, estimated that of the 21 million Americans with diabetes, 19 million have type 2, with one-third of those being unaware that they have it. Individuals with the following characteristics are at risk for type 2 diabetes:
• A lack of physical activity in their daily life
• A first-degree relative with type 2 diabetes (mother, father, or sibling)
• A high-risk ethnicity (African American, Latino, Native American, Asian American, or Pacific Islander)
• A personal history of gestational diabetes
• Delivered a baby weighing more than 9 pounds
• High blood pressure
• A low HDL (good) cholesterol level or high triglyceride level
• Polycystic ovary syndrome (PCOS)
• A history of pre-diabetes
• Acanthosis nigricans (a condition characterized by darkening of the skin folds of the armpits, neck, or groin; usually associated with obesity)
• A history of vascular problems (disease of the blood vessels)
Gestational Diabetes
Gestational diabetes occurs exclusively during pregnancy and affects about 7% of all pregnancies in the United States. In most cases, blood glucose levels return to normal after pregnancy. Women who have had gestational diabetes are more likely to develop it with subsequent pregnancies, and are at higher risk for type 2 diabetes later in life.
Pre-diabetes
Pre-diabetes occurs when blood glucose levels are higher than normal, but not yet high enough to be diagnosed as diabetes. Pre-diabetes 15 times more likely to develop type 2 diabetes than people with normal glucose values.
Diabetes Is Serious
According to a nationwide study conducted by the American Diabetes Association, only 32% of people perceived type 2 diabetes as a serious threat to their health. Keeping blood glucose levels in a near normal range has been shown to reduce the risk for complications diabetes—such as eye, kidney, and nerve disease—but glucose levels are not the only concern in diabetes management. Along with the potential for high blood glucose levels, many individuals with type have lipid (cholesterol and triglyceride) disorders, as well as hypertension (high blood pressure). If you have type 2 diabetes, this translates into a two to four times greater incidence of heart disease than those without diabetes. All of these concerns—blood glucose, blood pressure, and blood fats—should be addressed in a comprehensive treatment plan for optimal diabetes health outcomes.
Get Involved—Be a Part of Your Team
Dealing with diabetes day after day is a work in progress. You will have your work cut out for you, so don’t do it alone. Research indicates that a team approach is the most effective route to treating and managing your diabetes. The primary goal of treatment is the best possible blood glucose control. You are the key team member and know your diabetes better than anyone. You are involved in carrying out the recommendations of your diabetes care team that will best treat your disease. Typical team members include your physician, registered nurse, and registered dietitian (RD). Along with these health care professionals, your pharmacist and possibly a mental health professional round out the team for optimal diabetes care.
From time to time, you will need specialists on your team to help you with temporary issues. You may need a podiatrist if you have foot problems, or an obstetrician if you are a woman with diabetes planning to become pregnant. Your diabetes care team may also refer you to an eye specialist, such as an ophthalmologist or optometrist, for a retinal exam.
YOUR DIABETES DREAM TEAM
As an essential player on your diabetes care team, it is ultimately up to you to make sure all of the participants are present. Each team member has a particular role on the team and should work together for a common goal—your health.
| MEDICAL CARE | EDUCATION AND SUPPORT | SPECIALISTS |
| Primary care physician | Certified diabetes educator (CDE) | Ophthalmologist(eye care) |
| Endocrinologist | Registered nurse | Podiatrist (toe and foot care) |
| Advanced registered nurse practicioner | Dietitian | Nephrologist (kidney specialist) |
| Pharmacist | Neurologist (nerve specialist) | |
| Exercise physiologist | ||
| Mental health professional |
Diabetes Self-Management Education
Diabetes self-management education is sometimes referred to as diabetes self-management training and is valuable because it helps you learn more about the disease. Diabetes educators are health care professionals who focus on helping people with diabetes understand their disease and learn how to adjust their lifestyle and behavior with self-management skills. A diabetes educator may be a nurse, dietitian, pharmacist, or other health care professional. These health care professionals can become certified in specific areas of expertise like diabetes education and management.
A certified diabetes educator (CDE) credential demonstrates that the health care professional possesses distinct and specialized knowledge about diabetes and its treatment. The board certified—advanced diabetes management (BC-ADM) certification is available only for registered nurses, dietitians, and pharmacists who also have an advanced degree. This certification recognizes that the health care professional has met certain predetermined standards specified by that profession for specialty practice. Its purpose is to ensure the public that an individual has mastered a body of knowledge and acquired skills and abilities in a particular specialty.
Some diabetes educators are also certified pump trainers, meaning they have completed a program designed by an insulin pump company to enhance their knowledge and expertise in the operation and training process for a specific brand of insulin pump.
In some cases, a health care provider may have more than one specialty certification that is diabetes focused, as well as other certifications that are not specific to diabetes.
Healthy eating to all of their patients, so having diabetes is not a prerequisite for good nutrition. In reality, healthful eating plays a role in the prevention, as well as the treatment, of type diabetes. In the Diabetes Prevention Program study, the most effective methods of preventing type 2 diabetes included a combination of making healthier food choices with a 7% weight loss (on average) and increasing physical activity to include 30-minute exercise sessions at least five days every week.
For people with diabetes, the American Diabetes Association has identified four primary goals for healthy nutrition:
• Achieving and maintaining