Cystic Fibrosis-Related Diabetes (CFRD)

The most common types of diabetes are type 1 and type 2 diabetes. CFRD has some features that are common in both. Type 1 diabetes used to be called insulin-dependent or juvenile-onset diabetes. It occurs most often in childhood. People with type diabetes can’t make any insulin, so they must take insulin to stay alive. This is why type diabetes is often called “insulin-dependent diabetes.” People with type diabetes who miss insulin doses get very sick and can get ketoacidosis (a life-threatening change in blood acidity). Type 2 diabetes used to be called non–insulin dependent or adult-onset diabetes. It is caused by the lack of a normal response to insulin in addition to not making enough insulin. This type of diabetes occurs most often in overweight people over the age of 0. People with type 2 diabetes don’t often get ketoacidosis, but they can get very sick when their blood sugars are too high. People with type 2 diabetes do not always need insulin to manage their diabetes. Some use insulin. Some take pills. Most are told to lose weight. Some manage type 2 diabetes through diet and exercise alone.

Diabetes

T1DM: The body cannot make insulin

T2DM: The body lacks normal responses to insulin and does not make enough insulin

CFRD: The body cannot make or use insulin

Causes of CFRD

CFRD is unique, though it shares features with both type and type 2 diabetes. As in type diabetes, the pancreas does not make enough insulin. Thus, people with CF have insulin deficiency. This is likely due to scars in the pancreas because of thick mucus. Most people with CF make less insulin than normal, though not all with CF get diabetes. Some people with CF get diabetes because they may have insulin resistance. This means that the cells in the body do not use insulin the right way so more insulin is needed to change food into fuel and keep blood sugars in the normal range. Because many with CF have both insulin deficiency and insulin resistance, more people with CF get diabetes than do people without CF. Even when people with CF are not acutely ill, their chronic underlying infections can cause insulin resistance. A third cause of insulin resistance is higher than normal cortisol levels. The hormone cortisol is a steroid. It is made in the adrenal glands. Our bodies make higher than normal cortisol levels in response to stress. High cortisol levels get in the way of insulin’s action. Steroid-containing drugs (called corticosteroids) can also increase cortisol levels. These drugs are sometimes needed to treat lung disease. When taken, they can, for a little while, worsen blood sugar control. In people with CF who do not have diabetes, using corticosteroids can give them diabetes for a little while during and after corticosteroid treatment. People can have CFRD only sometimes (intermittent CFRD) or always (chronic CFRD). If you have intermittent CFRD, you may only need to take insulin when sick or during steroid treatment. If you have chronic CFRD, you need insulin treatment at all times to prevent high blood sugar levels. Although CFRD is unique from type or type 2 diabetes, the problems caused by diabetes are the same for all. These include eye, kidney, and nerve problems. These problems are caused by many years of blood sugar levels that are too high. Every person’s goal for diabetes treatment, no matter what kind they have, is to keep blood sugar levels as normal as they can. This helps to prevent diabetes-caused problems.

Complications with Hyperglycemia:

          Vision Problems

          Kidney Problems

          Neurological Problems (Nerve Damage)

Goal: To Keep Blood Sugar Levels Normal

              A1C: 7%

              A1C may also be reported as eAG: 154 mg/dl

              Before a meal (preprandial plasma glucose): 70–130 mg/dl

              1-2 hours after beginning of the meal (Postprandial plasma glucose)*: Less than 180 mg/dl

ADA Normal Blood Sugar Levels

Managing Cystic Fibrosis-Related Diabetes

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