Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. If left untreated, diabetes can cause many complications. Acute complications include diabetic ketoacidosis and nonketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease, stroke, kidney failure, foot ulcers and damage to the eyes. Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced.
Diabetes is referred to by the medical world as, 'Diabetes Mellitus,' and is a set of diseases where the person's body is unable to regulate the amount of sugar in their blood. The particular form of sugar that the person with diabetes is unable to regulate is called, 'glucose,' and is used in the body to give the person energy in order to do things in daily life such as walking, running, riding a bike, exercising, or other tasks. From food that people eat, the liver produces glucose and puts it into their blood.
In persons without diabetes, glucose levels are regulated by a number of hormones including one known as, 'Insulin.' An organ called the, 'Pancreas,' produces insulin, and also secretes additional enzymes which aid in the digestion of food. Insulin helps the movement of glucose through a person's blood into different cells, including muscle, fat, and liver cells so it can be used to fuel activity.
Several forms of diabetes involve the inability to both produce or use insulin properly. Persons with diabetes are unable to move glucose from their blood into their cells. The result is that the glucose remains in their blood, and damage occurs to the cells that need glucose for energy to perform activities, as well as harming tissues and organs that are exposed to increased amounts of glucose that has not been sent to the cells it should have gone to.
Type 1 Diabetes:
Type 1 diabetes is caused by a lack of insulin due to the destruction of insulin-producing beta cells in the pancreas. In type 1 diabetes, an autoimmune disease, the body's immune system attacks and destroys the beta cells. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. But in autoimmune diseases, the immune system attacks the body's own cells. In type 1 diabetes, beta cell destruction may take place over several years, but symptoms of the disease usually develop over a short period of time.
Type 2 Diabetes:
Type 2 diabetes , the most common form of diabetes, is caused by a combination of factors, including insulin resistance, a condition in which the body's muscle, fat, and liver cells do not use insulin effectively. Type 2 diabetes develops when the body can no longer produce enough insulin to compensate for the impaired ability to use insulin. Symptoms of type 2 diabetes may develop gradually and can be subtle; some people with type 2 diabetes remain undiagnosed for years. Type 2 diabetes develops most often in middle-aged and older people who are also overweight or obese. The disease, once rare in youth, is becoming more common in overweight and obese children and adolescents. Scientists think genetic susceptibility and environmental factors are the most likely triggers of type 2 diabetes.
Approximately ninety-percent of persons with diabetes have Type 2 diabetes, which is usually recognized when the person is an adult; commonly when they are over forty-five years of age. Other names this form of diabetes has been known by include, 'Non-Insulin Dependent Diabetes Mellitus,' or, 'Adult-Onset Diabetes Mellitus.' These other names are no longer appropriate because persons who are younger have this form of diabetes, and persons with Type 2 diabetes may also need to use insulin. Control of Type 2 Diabetes usually involves weight loss, diet, oral medications, and exercise.
Gestational Diabetes occurs when a woman is approximately halfway through pregnancy. Women who have this form of diabetes are more likely to have larger babies than women who do not have Gestational Diabetes. Women who experience Gestational Diabetes often find that it simply goes away, once they have delivered the baby, although women who have this form of diabetes are more likely to develop Type 2 Diabetes at a later point in their life.
Metabolic Syndrome involves a series of abnormalities, of which Type 2 Diabetes is a part. The syndrome involves not only Type 2 Diabetes, but high fat levels in the person's blood, hypertension, decreased HDL cholesterol, elevated LDL cholesterol, blood clotting, inflammatory responses, and central obesity. Metabolic Syndrome has a high rate of Cardiovascular Disease associated with it, and is also referred to as, 'Syndrome X.'
Pre-Diabetes is a condition that is related to Diabetes that has the potential to be reversed through both weight loss and exercise, which can prevent Type 2 Diabetes from occurring. Pre-Diabetes increases a person's risk of not only developing Type 2 Diabetes, but their risk of either a stroke, or heart disease. Persons with Pre-Diabetes experience blood sugar levels which are higher than they should be, yet are not high enough to be considered either Type 1 or Type 2 Diabetes.
Approximately one-third of the adults in North America who have diabetes are unaware that they have it. Around seventeen million adults in North America are aware that they have Diabetes, and one-million people each year are diagnosed with diabetes. Diabetes is found to be either the direct cause or a contributing factor in two-hundred thousand deaths each year, and the numbers of persons being diagnosed with diabetes is increasing rapidly. Obesity and sedentary lifestyles are among many reasons why diabetes is increasing.
Complications of Diabetes
Type 1 and Type 2 diabetes eventually lead to excessive levels of sugar in the blood; this condition is referred to as, 'Hyperglycemia.' Hyperglycemia damages the body in several ways, including damage to a person's kidneys, nerves, eyes, and blood vessels. The damage done through Hyperglycemia to a person's kidneys is known as, 'Diabetic Nephropathy,' and is a leading cause of kidney failure. The damage done to a person's nerves is referred to as, 'Diabetic Neuropathy,' and causes both foot wounds and ulcers, commonly leading to either foot or leg amputations. Damages to a person's Autonomic Nervous System can lead to a condition known as, 'Gastroparesis,' or paralysis of their stomach; it can also cause chronic diarrhea, and an inability in the person's body to control heart rate and blood pressure as they change posture. 'Diabetic Retinopathy,' is the medical name for damage done to a person's retinas in their eyes, and is a leading cause of blindness.
Diabetes can accelerate the formation of fatty plaque deposits inside a person's arteries or, 'Atherosclerosis,' leading to a clot or blockages. Results of the formation of these deposits can include a decrease in the circulation in the person's legs and arms called, 'Peripheral Vascular Disease,' or even a heart attack or stroke. Diabetes presents people who have it with a predisposition for such things as high cholesterol, high triglyceride levels, and high blood pressure. These conditions alone increase the risk of heart disease, blood vessel complications, and kidney disease; along with Hyperglycemia, the risks are even greater.
There are a number of infections that are associated with Diabetes which are often times more dangerous for a person who has diabetes due to their body's reduced ability to fight infections. For a person with diabetes, an infection may make control of glucose levels more difficult, delaying recovery from an infection.
Hypoglycemia occurs when a person with diabetes has a blood sugar level that is too low, which happens occasionally. When the person misses a meal, or exercises more than they usually do, or takes too much insulin or medication; drinks too much alcohol, or takes certain other medications in other conditions - they may become Hypoglycemic. The symptoms of Hypoglycemia include hand tremor, headaches, sweating, feeling dizzy, and poor concentration. Persons experiencing Hypoglycemia may faint, or experience a seizure if their blood sugar level becomes too low.
Diabetic Ketoacidosis involves uncontrolled Hyperglycemia and is a serious condition. It is usually caused by a highly inadequate level of insulin in a person's body which, over time, causes a buildup in their blood of Ketones. Ketones are acidic waste products, and are harmful to the body. Diabetic Ketoacidosis commonly affects persons with Type 1 Diabetes who don't have good control of their blood glucose levels. Trauma, infection, stress, missing medications such as insulin, or even a stroke or heart attack can precipitate Diabetic Ketoacidosis.
Hyperosmolar Hyperglycemic Nonketotic Syndrome is another serious condition that can affect persons with diabetes, and occurs when the person's blood sugar becomes very high. Their body attempts to rid itself of the excessive amounts of blood sugar through urinary output, which is increased significantly, often leading to dehydration. Persons with this syndrome can become so dehydrated that they may experience seizures, coma, or even die. Persons with Type 2 Diabetes who are not making efforts to control their blood sugar levels and have become dehydrated, are under stress, have experienced an injury, a stroke, or are taking some medications such as steroids, are typically those who experience this syndrome.
Causes of Diabetes
Type 1 Diabetes:
Type 1 Diabetes is something that is believed to be an autoimmune disease. The immune system in the person's body attacks the cells within the pancreas which produces insulin. There may be a predisposition to the development of Type 1 Diabetes in some families. There are some environmental factors, including some viral infections which are common that can also contribute to causing Type 1 Diabetes. Persons who are of Non-Hispanic, Northern European descent most commonly develop Type 1 Diabetes, followed by African Americans and Hispanic Americans. Persons of Asian descent rarely have Type 1 Diabetes. Slightly more men than women have Type 1 Diabetes.
Type 2 Diabetes:
Is something that has strong genetic links, and tends to run in families. Several of the genes involved have been identified; more are being studied that may be related to causes of Type 2 diabetes. There are several risk factors for developing Type 2 Diabetes. The risk factors include a high-fat diet, consuming high amounts of alcohol, a sedentary lifestyle, high blood pressure, high triglyceride levels, obesity, and Gestational Diabetes. Persons with a relative who had either Type 2 diabetes or Gestational Diabetes are at greater risk of developing Type 2 Diabetes. African Americans, Native Americans, Hispanic Americans, and Japanese Americans are at greater risk of developing Type 2 Diabetes. The risk of developing Type 2 Diabetes increases at age forty-five, and increases significantly after a person reaches age sixty-five.
Symptoms of Diabetes
Symptoms of Type 1 Diabetes may appear suddenly and are often dramatic. Increased stress may cause Diabetic Ketoacidosis, with symptoms that include vomiting and nausea followed by dehydration and serious disturbances in the person's blood levels of potassium. If the person is not treated, they may experience a coma, or die.
Symptoms of Type 2 Diabetes are many times subtle. They might be attributed to either obesity, or aging. Type 2 Diabetes may be precipitated by either stress, or steroids. Persons with Type 2 Diabetes may develop Hyperglycemic Hyperosmolar Nonketotic Syndrome. One of the more dismaying facts about Type 2 Diabetes is the a person may have it for years without knowing it.
Symptoms Common to Both Major Types of Diabetes
Fatigue: For persons with diabetes, their body cannot efficiently use glucose to provide energy, or is unable to at all. Instead, their body either partially or completely metabolizes fat as a source for energy, requiring more energy. The result of the body doing this is that the person feels fatigued or consistently tired.
Unexplained Weight Loss: Persons with diabetes are not able to process many of the calories the consume. Because of this, they might lose weight, even though the person might eat what seems to be an appropriate amount or even an excessive amount of food. Loss of sugars and water through urinary output and through dehydration can also contribute to weight loss in persons with diabetes.
Excessive Thirst: Persons with diabetes may develop high blood sugar levels which then overwhelm their kidney's ability to reabsorb sugars as their blood is filtered to produce urine. An excessive amount of urine is produced by their body as their kidney attempts to get rid of excess sugar, and the body attempts to counteract this by telling the brain to dilute their blood, translating it as a message to the person telling them they are thirsty. The body encourages water consumption in an effort to dilute high levels of blood sugar and reduce it to normal levels, as well as to compensate for any water that has been lost through increased urination. Excessive thirst in persons with diabetes is also referred to as, 'Polydipsia.' Excessive urination is referred to as, 'Polyuria.'
Excessive Eating: If the body of a person with diabetes is able to, it will secrete additional insulin in an effort to deal with higher blood sugar levels. Their body is also resistant to the action of insulin in Type 2 Diabetes, on of the functions of which is to stimulate hunger, and higher insulin level may lead to an increase in the person's hunger and the amount they eat. Despite eating more the person might gain very little weight; in fact - they may lose weight.
Poor Healing of Wounds: The presence of high levels of blood sugar prevents white blood cells, which are important in the body's defense against bacteria and in cleaning up dead tissue and cells, from working properly. Improper cell function leads to wounds which take longer to heal and have the potential to become infected more often. Diabetes that has been present for a lengthy period of time is associated with thickening of the blood vessels. This can prevent proper circulation, which is needed in order to deliver nutrients and oxygen to tissues in the body.
Infections: Some infection syndromes such as skin infections, urinary tract infections, and repetitive yeast infections, can be the result of a suppression of the person's immune system by diabetes through the presence of glucose in their tissues, which allows bacteria to grow. These skin infection syndromes may be an indicator of inadequate blood sugar control in persons with diabetes.
Altered Mental Status: Altered Mental Status in persons with diabetes may include inattention, confusion, extreme lethargy, agitation, or unexplained irritability. All of these may be signs that the person has one of several things, including ketoacidosis, hyperosmolar hyperglycemia nonketotic syndrome, high blood sugar, or hypoglycemia. Any of these conditions require immediate medical attention.
Blurry Vision: Persons with diabetes who have high blood sugar levels may experience blurry vision. There are other conditions that may cause blurry vision as well that are not specific to diabetes.
Testing and Exams for Diabetes
There are some tests that are used in order to diagnose diabetes, as well as to monitor blood sugar levels in persons who have already been diagnosed. If the person is presenting symptoms, but is not diagnosed with diabetes, evaluation should start with a complete medical interview followed by a physical exam. A health care provider asks about things such as the person's past medical issues, the symptoms they are experiencing, their risk factors for diabetes, and any medications they are currently taking. The health care provider will also ask about the person's family and whether there is a history of diabetes, their lifestyle and habits, and any other medical issues they may be experiencing.
Several laboratory tests are available to both health care providers and people in order to confirm a diagnosis of Diabetes.
Finger Stick Blood Glucose Test: This test can be performed in community-based screening programs, or anywhere, and provides rapid results. The test is not as accurate as blood testing in a laboratory; however, it provides rapid results, and it is very easy to perform. The results are accurate within ten-percent of laboratory values. Testing involves a minor finger-stick of the person's finger in order to obtain a tiny blood sample, which is then placed onto a strip. The strip is placed into a small machine that interprets the person's blood sugar level. At very high or low blood sugar levels, the finger-stick test may prove inaccurate, and is considered a preliminary screening. The majority of persons with diabetes use the finger-stick test to monitor their blood sugar levels.
Fasting Plasma Glucose Test: The Fasting Plasma Glucose Test involves asking the person to abstain from eating or drinking anything for eight hours prior to having a blood sample drawn. From the person's blood sample, information related to their glucose level is taken. If the person's glucose level while they are fasting is greater than or equal to 126 mg/dl they most likely have diabetes. If these findings are found in a person who has not been diagnosed with diabetes, a doctor may have the test repeated on another day in order to confirm the results. A doctor may have the person go through an, 'Oral Glucose Tolerance Test,' or possibly a, 'Glycosylated Hemoglobin Test,' commonly referred to as a, 'Hemoglobin A1c,' test for confirmation purposes.
If the person has a fasting glucose level that is more than 100, but less than 126 mg/dl - they are considered to have Pre-Diabetes. They do not yet have Diabetes, but they are at greater risk of developing it in the near future.
Oral Glucose Tolerance Test: An Oral Glucose Tolerance Test involves first drawing the person's fasting blood sugar level, and then drawing another blood sugar level two hours after they have consumed a drink containing seventy-five grams of sugar. If the person's blood sugar level after they have consumed the sugar drink is greater than or equal to 200 mg/dl they have Diabetes. If their blood sugar level is between 140 and 199 mg/dl, they are considered to have Pre-Diabetes.
Glycosylated Hemoglobin, or 'Hemoglobin A1c,' Test: The Hemoglobin A1c test measures how high the person's blood sugar levels have been over the last 120 days. The test involves drawing a blood sample, and is the best way to measure blood sugar control in persons with diabetes. If the test results show 7% or less, the person has good blood glucose control. If the person has 8% or higher test results, their blood sugar has been to high for too long.
The Hemoglobin A1c test in not as reliable for use in diagnosing diabetes, and is used more for follow-up care. Results showing greater than 6.1% are indicative of Diabetes, although confirmation testing would be needed before a diagnosis is reached. The test is commonly performed every three to six months for persons with diabetes. Persons who are having trouble maintaining control of their blood sugar levels may have the test done more often to help them maintain good control of their blood sugar levels.
Diagnosis the Complications of Diabetes
Persons with diabetes should have regular checkups to check for signs of complications caused by diabetes. Their regular health care provider can do many of these checks, others may need to be done by a specialist. The checks that need to be done include having their eyes checked at least once a year by an eye specialist to look for Diabetic Retinopathy. The persons urine needs to be checked on a regular basis; at least two or three times a year, because protein in their urine may be a sign of Nephropathy.
Health care providers can check the sensation in a person with diabetes legs using a tuning fork or mono-filament device to check for Diabetic Neuropathy. They can also check the person's lower legs and feet for things like blisters, cuts, scrapes or other lesions that may become infected. Persons with diabetes need regular screening for high cholesterol and high blood pressure, which can contribute to heart disease.
Treatment of Diabetes at Home
Diet, exercise, and other healthy habits can help persons with diabetes to improve their blood sugar control, as well as help them to either minimize or prevent entirely complications of diabetes.
Diet: A healthy diet is the key to control of blood sugar levels in persons with diabetes, and in the prevention of complications of diabetes. Persons who are overweight and having difficulty losing weight can work with their health care provider to find a dietitian, or a weight modification program to help them reach their goal weight. Eating a consistent and well-balanced diet which is low in saturated fat and concentrated sweets, as well as high in fiber, in about the same number of calories at the same times each day is the best thing. Doing so helps the person's health care provider to prescribe appropriate doses of either insulin or medication, and helps to keep blood sugar levels fairly even - as well as helping to avoid dangerously high or low blood sugar levels.
Exercise: Any form of exercise, done on a regular basis, can help to reduce the risk of developing diabetes in the first place. Exercise and also help to reduce risking complications of diabetes such as kidney failure, heart disease, leg ulcers, and blindness. Any form of exercise is beneficial; even twenty minutes of walking three times a week has proven beneficial. Some exercise is better than none at all. Some persons with diabetes who have experienced complications may wish to speak with a health care provider and ask them about an appropriate exercise program.
Alcohol Consumption: Persons with diabetes should either moderate, or eliminate their consumption of alcohol. They should not have more than seven drinks containing alcohol in a week; never more than two or three in one evening. One drink is 1.5 ounces of liquor, 12 ounces of beer, or 6 ounces of wine. For persons with Type 2 Diabetes, alcohol is a known risk factor for Neuritis, high or low blood sugar levels, and increased triglycerides.
Smoking: Persons with diabetes who smoke; no matter if it involves cigarettes, a pipe, a cigar, or another form of tobacco - increase their risk markedly for every complication of diabetes. Persons with diabetes who use tobacco and need help quitting should speak with their health care provider.
Blood Sugar Monitoring: Persons with diabetes need to check their blood sugar levels often. It is recommended that they check their blood sugar before meals, and before going to bed. They should record their blood sugar levels in a logbook, which also includes either insulin or medication doses and the times they were taken, what they have eaten and at what times, the exercise they have done, and any issues related to diabetes that were significant. A logbook provides highly useful information that a health care provider can use to see how the person is responding to treatment and other planning.
Body Mass Index: According to a study published in Annals of Internal Medicine, an increase in body mass index (BMI) over time is the most important factor contributing to the observed increase in diabetes prevalence since 1976. Diabetes is one of the most common and costly chronic disorders in the United States. Researchers analyzed data from National Health and Nutrition Examination Surveys to determine the extent to which the increase in diabetes prevalence is explained by changing distributions of race/ethnicity, age, and obesity prevalence in U.S. adults. They found the prevalence of diabetes nearly doubled from 1976 to 1980 and also from 1999 to 2004. During both time periods, diabetes prevalence increased more in men than in women. The increase of certain risk factors, including BMI, race and ethnicity, and age, coincided with an increased incidence of diabetes, with BMI being the greatest contributor among the three covariates. The researchers suggest that public health efforts should focus on interventions that address obesity. The increased prevalence of diabetes among men could not be explained by an increased BMI in men. Researchers suggest that future research should investigate what additional factors may contribute to the faster rise in diabetes in men than in women.
Medical Treatment of Diabetes
People are treated for diabetes individually depending on the type of diabetes they have. The form of treatment a health care worker provides also depends on whether or not the person has additional complications from diabetes and their general health at the time they are diagnosed. Treatment of diabetes involves lifestyle changes and blood sugar control, and creation of a plan to meet treatment goals.
Persons who have just been diagnosed with diabetes will often times find a care team spending a great deal of time educating them about the condition and its treatment, along with everything the person needs to know in regards to caring for themselves daily. The team includes not only a health care provider and their staff members; but specialists involved with eye care, foot care, Neurology, Diabetes Education, and a Professional Dietitian. The team interacts with the person who has diabetes at appropriate intervals to check on their progress and goals. Education is essential for persons with all types of diabetes.
Treatment of Type 1 Diabetes
Treatment of Type 1 Diabetes nearly always involves daily injections of insulin, usually in the form of a combination of short acting insulin. Insulin cannot be taken orally; if it were, the insulin would be destroyed in the person's stomach before it would be distributed in their bloodstream, which is where it is needed. The majority of persons with Type 1 Diabetes administer insulin injections to themselves. If someone else gives the person with diabetes their insulin injections, it is still important that the person with diabetes know how to administer the injection themselves in the event that another person is unavailable.
Persons with diabetes learn how to inject insulin from a trained professional, who will also show them how to store insulin; usually a Nurse who works with their health care provider, or diabetes educator. People with Type 1 Diabetes commonly inject insulin two or three times daily, usually around meal times. The amount of insulin they use depends on their individual needs as determined by their health care provider. There are some longer acting forms of insulin that are usually injected once or twice a day. Some persons with Type 1 Diabetes have the insulin they take administered continuously through an infusion pump in order to receive adequate control of their blood glucose levels.
If a person has taken insulin it is important that they eat because insulin will lower their blood sugar level whether they have eaten or not. If the person has taken insulin and not eaten, they risk hypoglycemia, also referred to as an, 'Insulin Reaction.' While persons with Type 1 Diabetes are learning how insulin affects them there is a period of time where they are adjusting. The adjustment period includes how different meals and exercise, as well as insulin affect them and their blood sugar levels.
It is important to learn to keep blood sugar levels as even as possible. Equally important is maintaining an accurate record of the person's insulin dosages and blood sugar levels; health care providers will need this information in order to provide treatment and management of diabetes for them. Pursuing a consistently healthy diet that is right for their weight and size is just as important in the effort to control the person's blood sugar levels.
Treatment of Type 2 Diabetes
Persons with Type 2 Diabetes may have the opportunity to lower their blood sugar levels without the need for medication, if their HbA1c test results warrant this opportunity. Losing weight and exercising are the best ways to lower blood sugar levels in persons with Type 2 Diabetes. If a person with this type of diabetes is presented with this opportunity, they may have from three to six months before their blood sugar and HbA1c test is checked again. If the blood sugar levels are still high in the results, the person will start taking oral diabetes medication to control blood sugar levels.
While on oral medication for Type 2 Diabetes, it is important to lose weight if the person is overweight, eat a healthy diet, and pursue appropriate exercise. The person's health care provider will monitor their progress while they are taking oral medication closely after they have started taking it to ensure that the proper dose is being administered, and to make sure that side-effects are at a minimum.
The person's health care provider may choose to combine two forms of medication in order to achieve blood sugar levels that are within an appropriate range. Over time, persons with Type 2 Diabetes may need insulin injections in order to achieve control of blood sugar levels. It is now becoming more common for persons with Type 2 Diabetes to use a combination of insulin injections and medication to control their blood sugar levels.
The leading cause of death in all industrialized nations is diabetes, and persons with diabetes have twice the risk of premature death than those who do not have it. Their prognosis is dependent on the type of diabetes they have, the development of any complications, as well as the control they have over their blood sugar levels.
Type 1 Diabetes
Approximately 15% of persons with Type 1 Diabetes die before reaching forty years of age; twenty-times the rate of that particular age group in the general population. Their most common cause of death is Diabetic Ketoacidosis, Heart Failure, or Kidney Failure. The prognosis for persons with Type 1 Diabetes may be improved through good blood sugar control, which has been proven to slow the progression of diabetes, or even prevent it, and even improve complications in persons with Type 1 Diabetes.
Type 2 Diabetes
Persons with Type 2 Diabetes who have been diagnosed while in their forties have a life-expectancy which is decreased by five to ten years because of the diagnosis. The leading cause of death among persons with this type of diabetes is Heart Disease. Strict blood pressure control and good blood sugar monitoring at a recommended level of less than 100 mg/dl, as well as, 'good cholesterol,' and the use of Aspirin when indicated, can slow down the progression of this type of diabetes or prevent or improve any complications.
The awareness ribbon color for Diabetes was gray, however more commonly diabetes is now symbolized by the blue circle, as designated by the International Diabetes Federation. American Diabetes Month takes place each November, and November 14 is declared World Diabetes Day (WDD). Led by the International Diabetes Federation, the day unites the global diabetes community to produce a powerful voice for diabetes awareness and advocacy.
Blood Sugar Levels Including Printable Chart - Thomas C. Weiss - (2014-03-27)
Low Glycemic Index Foods for Breakfast to Control Daily Blood Sugar - Institute of Food Science & Technology - (2012-04-04)
Full List of Diabetes Documents (63 Items)