Glossary of Diabetes-Related Terms From: The Diabetes Sourcebook By Diana W. Guthrie, R.N., Ph.D., and Richard A. Guthrie, M.D. AADE - American Association of Diabetes Educators. A national voluntary organization of professionals interested in education of the person and/or family with diabetes. acetoacetic acid - An acid that also contains a ketone group in its molecule. acetone - A ketone formed in greater abundance in the liver from fatty acids when glucose is not available to the cells for energy. Acetone, one of three ketones, is found in the blood and urine of people with uncontrolled diabetes and causes the breath to have a fruity odor. acidosis - An acid condition of the body resulting from abnormal amounts of acid, such as acetoacetic and beta hydroxybutyric acids. Acidosis occurs in people who are not producing insulin or who do not receive enough insulin. ADA - American Diabetes Association, Incorporated, is a national voluntary health organization of professional and lay people interested in research, service, and education in the field of diabetes. adrenal glands - Two tent-shaped organs that secrete epinephrine (see epinephrine) and glucocorticoids (see glucocorticoids) and aldosterone. adult diabetes - Now called Type 2 or non-insulin-dependent diabetes mellitus. (See Type 2 diabetes.) alpha cells - Cells that produce glucagon; found in the islets of Langerhans of the pancreas. angiopathy - Blood-vessel disease (see microangiopathy and macroangiopathy). atrophy - The shrinking of a body part due to lack of nutrition. In diabetes, this may mean a decrease in the amount of fat under the skin. This sometimes occurs at the sites of insulin injection and results in hollowed-out areas that are cosmetically undesirable. basement membrane - Layers of concentric circles, or chains, of glycoproteins separated by infrequent glucose and galactose molecules, protectively surrounding cells of the capillaries of kidney, muscle, retina of the eye, etc. beta cells - Cells that produce insulin; found in the islet of Langerhans of the pancreas. beta hydroxybutyric acid - One product of metabolized fat. biguanides - Drugs, such as phenformin (DBI and DBI-TD), have also been used in treating diabetes. They do not stimulate the pancreas to produce more insulin but prevent glucose uptake from the intestine, prevent gluconeogenesis, and promote the breakdown of glucose, among other actions. Although these drugs are not now available in the United States, a new phenformin called metformin is being tested. It is found to be less of a cause of lactic acidosis, a side effect seen in the use of the earlier drugs. blood-glucose level - The concentration of glucose in the blood. It is commonly called blood sugar and is usually measured in milligrams per deciliter (mg/dl) or in millimoles (mmol). blood-glucose meter - A hand-held machine that tests blood-glucose levels. A drop of blood, obtained by pricking a finger, is placed on a small strip that is inserted in the meter which calculates and displays the blood-glucose level. brittle diabetes - A type of Type 1 diabetes in which the blood-glucose level fluctuates widely from high to low. Brittle diabetes can be caused by the complete loss of ability to produce any insulin, by too high an insulin dose, or by other factors. It can often be improved through a good treatment program. Also called unstable diabetes. callus - A thickening of the skin caused by friction or pressure. calorie - A unit for the measurement of heat. The heat-producing, or energy-producing, value of foods is measured in calories. A true calorie is such a small unit that 1,000 calories - a kilocalorie - is usually referred to as a calorie when discussing caloric values of food. calorie content - The amount of heat released on the burning of one gram of food, most correctly called a kilocalorie (k). carbohydrate - One of the three main constituents of foods. Carbohydrates are composed mainly of sugars and starches. cardiovascular disease - Disease of the heart and large blood vessels; tends to occur more often and at a younger age in people with diabetes and may be related to how well the diabetes is controlled. cell membrane - The material that surrounds all cells and acts to retain helpful substances, exclude harmful substances, and allow glucose to pass into the cells (with the help of insulin). cesarean section - An operation in which an infant is delivered by being removed from the mother's womb through an incision in the abdomen. Infants of diabetic mothers (IDM) are frequently delivered before term by this means. Charcot's joint - Chronic progressive degeneration of the stress-bearing action of a joint (i.e., ankles). cholesterol - A mixture of lipoproteins found in blood, consisting of HDL (high-density lipoproteins), LDL (low-density lipoproteins), and VLDL (very-low-density lipoproteins). Present recommendations are to keep cholesterol levels below 200 mg/dl. closed-loop system - A self-controlled blood-glucose control system (artificial pancreas or artificial beta cell). conventional control - One or two doses of insulin with blood sugars higher than normal 50 percent or more of the time. corns - Hard, thickened areas of the skin caused by friction or pressure. These usually occur on the feet and may result in foot ulcers in people who have a loss of pain sensation in their feet. DCCT - Diabetes Control and Complications Trial - A 10-year research study sponsored by the National Institutes of Health (NIH) involving more than 1,400 people with Type I diabetes. The study proved that tight blood-glucose control can prevent or delay diabetic complications related to hyperglycemia. dawn phenomenon - An early-morning rise in blood-glucose levels, believed to be due to a delayed response in growth-hormone release. diabetes mellitus - A disease in which the body is unable to use and store glucose normally because of a decrease or lack of insulin production. Diabetes mellitus is usually inherited, but it may be caused by any process that destroys the pancreas (usually the beta cells) or alters the effectiveness of the receptor site on the cell membrane. diabetic coma - Unconsciousness occurring during ketoacidosis. Associated symptoms include dry skin and mouth, fruity odor of the breath, very deep and rapid respirations, rapid pulse, and low blood pressure. Diabetic coma is caused by a deficiency of insulin. diabetic ketoacidosis (DKA) - The most severe state of diabetes, in which there are markedly elevated glucose levels in blood and urine, elevated ketones in blood and urine, dehydration, and electrolyte imbalance. (See ketoacidosis.) diabetic ketosis - A serious state of diabetes in which there is glucose in blood and urine, ketones in blood and urine, and possibly some dehydration. (See ketosis.) dialysis - A method of washing the toxins out of the blood. Peritoneal dialysis is done at home (usually 4 hours in, 4 hours out); hemodialysis is done at home (usually 12 hours in, 12 hours out) or at a center. double-void technique - The procedure of collecting a urine specimen 30 minutes after first voiding of all the urine. The double-voiding technique is often used in collecting urine to test for glucose and acetone levels. It is a rough measure of diabetes control at that particular time. epinephrine - A hormone released from the adrenal glands. Its main function in diabetes is to release glucose from the liver, increase the circulation rate, and prevent release of secreted insulin. exchange - A serving of food that contains known and relatively constant amounts of carbohydrate, fat, and/or protein. The food used in an exchange is usually weighed or measured. The exchanges are divided into several groups: milk, fruit, meat, fat, bread, and vegetables. fasting blood glucose - Blood-glucose concentration in the morning before breakfast. Commonly called fasting blood sugar (FBS). fat - One of the three main constituents of foods. Fats occur in nearly pure form as liquids or solids, such as oils and margarines, or they may be a component of other foods. Fats may be of animal or vegetable origin. They have a higher energy content than any other food (9 calories per gram). fatty acids - Constituents of fat. When there is an insulin deficiency, as in diabetes, fatty acids increase in the blood and are used by the liver to produce ketones. fiber - Aids in the normal functioning of the digestive system, specifically the intestinal tract. flocculation - A "snowy" look to insulin that may occur when the insulin has been exposed to too high or too low a temperature or when it is out of date. fluorescein angiopathy - Procedure in which photographs of the retina are taken after a water-soluble dye has been injected into the vein. fractional urine - Urine collected over a period of time and used to test for glucose and acetone levels. Fractions of urine are usually collected over 24 hours: from breakfast to lunchtime, from lunchtime to suppertime, from suppertime to bedtime, and from bedtime to rising. Also called block urine. gangrene - The death of tissue caused by a very poor blood supply, as sometimes occurs in the feet and legs of persons with diabetes. Infection may be a contributing cause. genes - Basic units of hereditary characteristics passed on through reproduction (part of chromosomes). gestational diabetes - A period of abnormal glucose tolerance that occurs during pregnancy, usually controlled by diet and possibly insulin. globin insulin - Modified form of insulin produced by attaching a globin molecule to Regular insulin, slowing absorption and extending the peak and duration of action. Globin insulin is a clear insulin with acidic pH and intermediate action. It is no longer on the market. glucagon - A hormone produced by the alpha cells in the islet of Langerhans of the pancreas. Glucagon causes a rise in the blood - glucose level by releasing glucose from liver and muscle cells. It is used by injection for the treatment of severe insulin reactions at home, school, or work. glucocorticoids - Hormones released from the cortex of the adrenal gland; in relation to diabetes, they cause amino acids to be changed into new glucose (gluconeogenesis). gluconeogenesis - The process of converting amino acids and glycerol to new glucose. This process takes place in the liver and muscle cells of the body. glucose - The simple sugar, also known as dextrose, that is found in the blood and is used by the body for energy. glucose tolerance - The ability of the body to use and store glucose. Glucose tolerance is zero in persons with diabetes mellitus. glucose-tolerance test - A test for diabetes mellitus. The person being tested is given a measured amount of glucose to drink; blood - glucose levels are measured before ingestion and 1/2, 1 1/2, 2, 3, and sometimes 4 to 6 hours after ingestion. Also called oral glucose tolerance test (OGTT). glucose toxicity - A state in which the lack of insulin, due to a decreased availability and/or function of the cell receptor site to receive insulin, results in an increase of glucose in the body, which is toxic to the beta cells in the islet of Langerhans. This toxicity is such that it may even lead to beta cell death. glycogen - Glycogen is glucose in storage form in the liver. It may be broken down to form blood glucose during an insulin reaction or during a fast. glycogenesis - The process whereby the liver converts a portion of glucose to glycogen. glycogenolysis - The breakdown of glycogen to glucose. glycohemoglobin - A test that reflects average blood-glucose control for about 3 to 4 months before the test. One test is the hemoglobin A1c. glycolysis - The breakdown of glucose to carbon dioxide and water. glycosuria - The presence of glucose in the urine (glyco refers to sugar, uria to urine). gram - A small unit of weight in the metric system. Used in weighing food to determine a specific amount to eat or to burn in calories (1 pound [16 ounces] equals 453 grams). health-care team - The group of professionals who help manage diabetes and which may include a physician, registered dietitian, and certified diabetes educator, ophthalmologist, podiatrist, or other specialists. heart disease - A cardiovascular condition in which the heart does not efficiently pump blood. People with diabetes are at greater risk for developing heart disease than is the general population. heredity - The transmission of a trait, such as blue eyes, from parents to offspring. hormone - A chemical substance produced by one gland or tissue and carried by the blood to other tissues or organs, where it stimulates action and causes a specific effect. Insulin and glucagon are hormones. hyperbilirubinemia - Condition in which a person has greater-than-normal value (+12.50 mg/dl in the infant) of bilirubin in the blood. Signs: jaundiced look to skin and whites of eyes. hyperglycemia - A greater-than-normal level of glucose in the blood (high blood glucose). Fasting blood-glucose values greater than 105 mg/dl (5.8 mmol) are suspect; greater than 140 mg/dl (7.8 mmol) are diagnostic. hyperinsulinism - An excessive amount of insulin, which may be caused by overproduction of insulin by the beta cells of the islets of Langerhans in the pancreas or by an excessive dose of insulin. Hyperinsulinism may cause hypoglycemia (low blood-glucose levels). hypertension - High blood pressure. Found to aggravate diabetes control or the complications already developed. hypocalcemia - Less-than-normal value (10-12 mg/dl in the infant) of calcium in the blood. Signs: convulsive seizure and irritability of the neuromuscular system. hypoglycemia - A less-than-normal level of glucose in the blood (low blood-glucose level). Fasting blood-glucose value less than 60 mg/dl (3.3 mmol). hypoglycemic agent - A drug or substance, such as sulfonylureas (e.g., Tolbutamide) and glipizide, used to reduce blood-glucose levels. impaired glucose tolerance - Condition that exists when blood-glucose values are elevated above normal but are inconclusive for diabetes. Sometimes mistakenly called borderline diabetes. insulin - A hormone secreted by the beta cells of the islets of Langerhans in the pancreas. Promotes the utilization of glucose. insulin-dependent diabetes mellitus (IDDM) - Also called Type 1 diabetes or juvenile diabetes. insulin reaction - A condition with rapidly occurring onset that is the result of low blood-glucose levels. It may be caused by too much insulin, too little food, or an increase in exercise without a corresponding increase in food or decrease in insulin. Symptoms may vary from nervousness, shakiness, headaches, and drowsiness to confusion and convulsions, and even to coma. insulin resistance - A condition in which the body does not properly respond to insulin. It is the most common cause of Type 2 diabetes. intensive control - Three or more doses of insulin per day or use of the insulin infusion pump with blood sugars in the normal or near normal range 80 percent or more of the time. islets of Langerhans - The small groups of cells in the pancreas that contain alpha, beta, and delta cells and produce glucagon, insulin, and somatostatin. isophane insulin - NPH (neutral protamine Hagedorn) insulin, a neutral pH, intermediate-acting insulin. juvenile diabetes - Now called Type 1 or insulin-dependent diabetes mellitus (IDDM). ketoacidosis - A condition of the body in which there is not enough insulin. Free fatty acids are released from fat cells and produce ketones in the liver. These ketones or acids result in an imbalance of the blood (acidosis). In the more acute state, the result is ketoacidosis. Large amounts of sugar and ketones are found in urine, electrolytes are imbalanced, and dehydration is present. The onset is usually slow. The condition leads to loss of appetite, abdominal pain, nausea and vomiting, rapid and deep respiration, and coma. Death may occur. ketone bodies - A name given by some to a mixture of ketones and other metabolism products that may break down into ketones. These other metabolism products are usually acetoacetic acid (which has a ketone group within the molecule) and beta hydroxybutyric acid (a molecule very similar to acetoacetic acid). ketonemia - The presence of ketones in the blood. ketones - Substances formed in the blood when a fat is broken down because of insufficient insulin. Fats are broken down into fatty acids, which are then chemically changed into ketones. Ketones (usually acetone) are often found in the blood and urine of persons with uncontrolled diabetes. Ketones may produce a fruity odor in the breath and urine of a person. ketonuria - The presence of ketones in the urine. ketosis - The presence of large amounts of ketones in the body, secondary to excessive breakdown of fat caused by insufficient insulin in a person with diabetes mellitus. Acidosis precedes and causes ketosis; the combination (ketosis and acidosis) is called ketoacidosis. Ketosis can also result from starvation or illness in nondiabetic individuals. kidney threshold - The level of a substance (such as glucose) in the blood in the kidney, above which it will be spilled into the urine. Also called renal threshold. Kimmelstiel-Wilson syndrome - Lesions of the filtered tubules of the kidney, caused by blood-vessel degeneration related to poorly controlled diabetes, as described by doctors Kimmelstiel and Wilson. Kussmaul's inspiration - The rapid, deep, and labored respiration observed in patients with diabetic ketoacidosis; an involuntary mechanism to excrete carbon dioxide in order to reduce carbonic-acid level. labile diabetes - A term used for unstable diabetes control. (See brittle diabetes.) Lente insulin - An intermediate-acting insulin that is a mixture of 30 percent Semilente and 70 percent Ultralente insulin. lipolysis - The increased fat breakdown in the body tissues that occurs in ketosis (lysis of fat). Liver Activation Treatment - (Pulsatile IntraVenous Insulin Treatment) insulin given by vein in a pulselike fashion (insulin based on total body needs given in short spurts every few seconds while the person sips a high glucose-loaded drink). macroangiopathy - Disease related to the large blood vessels of the body. maturity-onset diabetes - Another name for Type 2 diabetes (also called adult diabetes, non-insulin-dependent diabetes, mild diabetes, ketone-resistant diabetes). Mauriac syndrome - A condition observed before puberty in children with prolonged, poorly controlled diabetes. It involves an enlarged, fatty liver, pitting edema, and short stature. The Mauriac syndrome is seldom seen today due to proper treatment, with adequate food and insulin provided for growth. meal plan - An arrangement whereby the total food allowed daily is expressed in terms of a certain number of points or exchanges, with the foods to be eaten at specific times. metabolism - All the chemical processes in the body, including those by which foods are broken down and used for tissue or energy production. mg/dl (milligrams per deciliter) - The unit of measure used to describe blood-glucose levels. microaneurysms - Small ballooned-out areas on the capillary blood vessels, such as might be found on the retina of the eye. They may burst and bleed. microangiopathy - Disease related to the small blood vessels of the body. monounsaturated fat - Has effect similar to that of polyunsaturated fat but does not lower HDL cholesterol. Found in olive oil and other oils. nephropathy - Disease of the kidneys which can be life-threatening. neuritis - Inflammation of the nerves. neuropathy - Any disease of the nervous system. Neuropathy may occur in persons with diabetes and be related to poor control. Symptoms such as pain, loss of sensation, loss of reflexes, and/or weakness may occur. non-insulin-dependent diabetes (NIDDM) - Also called Type 2 diabetes. NPH - Neutral Protamine Hagedorn, an intermediate-acting insulin that initially received its slower action through the addition of a protein to short-acting insulin. obesity - An abnormal and excessive amount of body fat. Obesity is a risk factor for Type 2 diabetes. omega - Three fatty acids that are useful in lowering triglycerides and cholesterol. They also slow blood clotting. Found in salmon, tuna, and certain other fish. open-loop system - A mechanical system of insulin injection that is not self-controlled but must be controlled or programmed externally. oral agents (oral hypoglycemic agents) - Medications taken orally to lower blood glucose. They are used by people with Type 2 diabetes and should not be confused with insulin. oral glucose-tolerance test (OGGT) - See glucose-tolerance test. oral hypoglycemia agent - Another name for a blood-glucose-lowering agent. (See hypoglycemic agent.) pancreas - A gland that is positioned near the stomach and that secretes at least two hormones - insulin and glucagon - and many digestive enzymes. pancreas, artificial - A mechanical device that stimulates the functions of the beta cells. It withdraws blood continuously, measures the glucose level, and injects an appropriate dose of insulin or glucose to reestablish a normal blood-glucose level. points system - A method of quantitating food intake by assigning points to various food components (carbohydrate, fat, protein, calories, sodium, etc.) and determining the number of each component point needed for a meal or for a day's intake. This system may either substitute for or accompany the less precise exchange system for diet calculation (75k = 1 point). polydipsia - Excessive thirst, with increased drinking of water. polyphagia - Excessive hunger or appetite, resulting in increased food intake. polyunsaturated fat - The type of fat that is liquid at room temperature, unless hydrogenated. Includes corn and certain other vegetable oils. polyuria - Excessive output of urine. postprandial - Occurring after a meal. potential abnormality of glucose tolerance - The time during the life of a diabetic person before any abnormality in glucose tolerance can be demonstrated. The identical twin of a person with diabetes is thought to have potential abnormality of glucose tolerance. precipitate - Particles that settle out of solution. This may occur in insulin that is kept beyond the expiration date, is contaminated, or is improperly mixed. previous abnormality of glucose tolerance - A classification used for the person who has been documented to have hyperglycemia during pregnancy, illness, or other crisis but who currently has relatively normal blood-glucose levels without any treatment. protamine zinc insulin (PZI) - A long-acting insulin, prepared with large amounts of protamine combined with Regular insulin in the presence of zinc. protein - One of the three main constituents of foods. Proteins are made up of amino acids and are found in foods such as milk, meat, fish, and eggs. Proteins are essential constituents of all living cells and are the nitrogen-containing nutrient. The calorie content of protein is four calories per gram. Regular insulin - Short-acting insulin crystallized from the pancreas of animals or synthetically made. This insulin is neutralized and can be premixed with NPH insulin. Also known as clear insulin or crystalline insulin. renal - Pertaining to the kidneys. renal threshold - Another name for kidney threshold. respiratory distress syndrome (RDS) - Difficulty in breathing, noted by grunting, respiratory or expiratory wheezing or both, labored respiration, cyanosis (a blueness o f the lips, face, fingers, and toes that can expand to involve the total body), and abnormal rate of respiration. retina - The light-sensitive layer at the back of the inner surface of the eyeball. retinopathy - Disease of the retina. Retinopathy occurs in persons with prolonged, poorly controlled diabetes and involves abnormal growth of and bleeding from the capillary blood vessels in the eye. saturated fat - The type of fat, such as butter, that is usually solid at room temperature. Saturated fats are usually derived from animal sources. self-monitoring of blood glucose (SMBG) - A technique of testing a person's blood-glucose level in order to determine the body response to activity, food, and medication. Semilente - Insulin prepared through special crystallizing techniques to produce small insulin crystals with large absorptive surfaces and rapid action. Semilente is slower in action than Regular insulin but more rapid than the intermediate-acting insulin. serum glucose - The concentration of glucose in the liquid part of the blood after the cells have been removed (clotted blood). single-void technique - The procedure of collecting a urine specimen four times a day, before meals and at bedtime. The bladder is not emptied for 30 minutes before the specimen is collected. Somogyi effect - A phenomenon (described by the biochemist Somogyi) in which hypoglycemia causes activation of the internal counterregulatory hormones (for example, glucagon, growth hormone, and epinephrine), causing a rebound in the blood-glucose level to hyperglycemic levels. Also called post-hypoglycemia hyperglycemia. spot test - A urine test performed on a sample collected using the single-void technique. sugar - A form of carbohydrate that provides calories and raises blood glucose levels. sugar substitutes - Sweeteners, such as saccharin, acesulfame K, and aspartame, that are used as a substitute for sugar. sulfonylureas - Chemical compounds that stimulate production or release of insulin by the beta cells in the pancreas and/or prevent release of glucose from the liver. They are used in the treatment of Type 2 diabetes. time-action curve - A curve that shows the effect of a medicine at various times after it is taken. twenty-four-hour urine - Used to measure quantitative glucose levels in urine from a pooled, twenty-four-hour specimen. Type I diabetes - Results from inability to make insulin due to a combination of genetics or inheritance and environmentalstressors. Insulin-dependent diabetes mellitus is associated with insulin's lack of availability, its action on the receptor sites, and/or its function with the glycolytic pathway. Also called insulin-dependent diabetes or juvenile diabetes. Type II diabetes - A type of diabetes that is usually found in adults over 30 years of age. The onset is gradual, and the symptoms are often minimal. Patients are often overweight. Those with Type 2 are less prone to acute complications, such as acidosis and coma, than are patients with Type 1. Type 2 diabetes is treated through diet alone or through diet plus oral hypoglycemic agents. Insulin injections may or may not be required. Also called non-insulin-dependent diabetes, non-ketosis-prone diabetes, or maturity-onset diabetes. (Previously called adult diabetes or maturity-onset diabetes in the young [MODY].) Ultralente - A long-acting insulin that is prepared using special crystallizing techniques that produce large crystals with small absorptive surfaces. Similar in action to PZI. unsaturated fats - The type of fat, such as vegetable oil, that is usually liquid at room temperature. (See monounsaturated fat and polyunsaturated fat.) unstable diabetes - Another name for brittle diabetes. urine tests - Tests that measure substances in the urine. They provide a general idea of a patient's blood-glucose level several hours before the test. Urine tests for ketones are important for preventing ketoacidosis. Copyright © 1999 by Diana W. Guthrie, R.N., Ph.D., and Richard A. Guthrie, M.D. From The Diabetes Sourcebook: Today's Methods and Ways to Give Yourself the Best Care, by arrangement with Lowell House.