1. What is Diabetes?
   Chronic diabetes conditions include type 1 and type 2 diabetes. Type 1 diabetes can occur at any age, but it is most often diagnosed in children, teens or young adults. In this disease, the body makes little or no insulin. Daily injections of insulin are needed. The exact cause is unknown. Type 2 diabetes makes up approximately 90 percent of diabetes cases. It most often occurs in adulthood, but teens and young adults are now being diagnosed with it because of high obesity rates. Many people with type 2 diabetes do not know they have it.
   Potentially reversible diabetes conditions include pre-diabetes – when blood sugar levels are higher than normal, but not high enough to be classified as diabetes – and gestational diabetes, which occurs during pregnancy.
   
   
2. Symptoms
   Diabetes symptoms vary depending on the levels of blood sugar elevation. Some of the signs and symptoms of type 1 and type 2 diabetes include: increased thirst, frequent urination, extreme hunger, unexplained weight loss, fatigue, blurred vision, slow-healing sores, mild high blood pressure, and frequent infections, such as gum or skin infections and vaginal or bladder infections.
   A routine blood test made during an annual physical examination may reveal diabetes. Because type 2 diabetes develops slowly, some people with high blood sugar have no symptoms. Symptoms of type 1 diabetes develop over a short period of time. People may be very sick by the time they are diagnosed.
   
   
3. Treatment
   There is no cure for diabetes, but it can be managed with medicines, diet and exercise to control blood sugar and prevent symptoms and problems. Patients with type 1 diabetes require insulin. Several classes of type 2 diabetes medicines exist. Each works in different ways to lower blood sugar. A drug may work by stimulating the body to produce more insulin, inhibiting the production and release of glucose from the liver, blocking the action of stomach enzymes that break down carbohydrates, or by improving the sensitivity of cells to insulin. People with diabetes often need to monitor blood sugar levels with a test strip that uses a small amount of blood.
   
   
4. Risk Factors
   Risk factors for diabetes depend on the type of diabetes. Type 1 diabetes has a large genetic component and the risk increases if a parent or sibling has type 1 diabetes. Type 2 diabetes has numerous risk factors. These include obesity, inactivity, family history, race and age.
   
   
5. Dermatological Complications
   Diabetes frequently has skin manifestations. Glucose attaches to protein and has an effect on the structure and function of that protein, and in the case of skin it accounts for visible changes. Increased crosslinking of collagen has been suggested as responsible for the generally thicker skin of diabetics compared to non-diabetics. Advanced glycosylation end products are probably responsible for yellowing of skin and nails. Increased viscosity of blood due to stiff red blood cell membranes results in engorgement of the fine blood vessels in skin, detected as redness of the face.
   Anyone treating the skin of a person with diabetes should be aware of certain skin conditions linked to diabetes and insulin resistance. Diabetes can be associated with the darkening and thickening of certain areas of the skin, especially in the skin folds, loss of skin pigment resulting in patches of discolored skin and slower wound healing.
   
   
6. Complications of Diabetes
   Long-term complications of diabetes develop gradually. The greater the duration of the less controlled the blood sugar, the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening.
   Possible complications include cardiovascular disease, nerve damage (neuropathy), kidney damage (nephropathy), eye damage (retinopathy), foot damage and skin and mouth conditions.
   
   
7. Attention to Manicures and Pedicures
   Fungal nail infections, especially toenail infections are common in diabetics. Any aesthetic procedure such as manicures and pedicures requires heightened vigilance since diabetes renders individuals more susceptible to infections.
   To avoid infections, technicians should sterilize equipment before and after use, and avoid manipulating cuticles or nicking the skin. For diabetic clients, vigorous use of a pumice stone or foot file is discouraged. Wound healing is slower in people with diabetes. Another precaution is to avoid the use of heat. People with diabetes may not register the pain of burning. When performing treatments on the feet, it is prudent to look for telltale signs such as dark splotches on the dermis, thinning of skin that causes shininess, or a yellowish plaque that forms over shins. Some people may be unaware that they have diabetes.
   
   
8. Infection Concerns
   People with diabetes are susceptible to developing infections. Some diabetes-related health issues, such as nerve damage and reduced blood flow to the extremities, increase the body's vulnerability to infection. Particular attention should be paid to areas around nails and between the fingers and toes.
   Diabetes is a contradiction for body waxing. The potential of tearing delicate skin gives bacteria an opportunity to enter the body. The waxing process also creates inflammation, which can trap bacteria beneath the skin.
   
   
9. Living with Diabetes
   Keeping an ideal body weight and an active lifestyle may prevent type 2 diabetes. There is no way to prevent type 1 diabetes.
   Eating a healthy diet, maintaining a healthy weight and watching blood sugar levels are central to managing diabetes. Plenty of fruits, vegetables and whole grains (all high in nutrition and low in fat and calories) are recommended.
   Maintain physical activity with at least 30 minutes or more of aerobic activity most days of the week. Exercise lowers blood sugar levels and increases insulin sensitivity, which means your body needs less insulin.
   Monitor blood sugar carefully as it is the only way to make sure that levels remain within the target range. Despite maintaining a rigid meal schedule, blood sugar levels can change in response to food, physical activity, medications, illness, alcohol, stress and – for both men and women – fluctuations in hormone levels.
   
   
10. Outlook (Prognosis)
    After many years, diabetes can lead to serious problems. Both women and men with diabetes are at risk. Control of blood sugar and blood pressure can reduce the risk of death, stroke, heart failure and other diabetes problems. Some people with type 2 diabetes no longer need medicine if they lose weight and become more active. When they reach their ideal weight, their body's own insulin and a healthy diet can control their blood sugar levels.

Aestheticians need to be aware of the complications of diabetes when assessing their clients for any procedure. Diabetics deal with many health concerns, but with a few adjustments you can make sure that your services cater to their specialized needs. By incorporating detailed client consultations into your spa's protocol, providing services that address specific symptoms, and following through with personalized recommendations, you will improve the well-being of these clients. In turn, they will prove loyal over the long haul.

Dr. Annette Tobia received her Ph.D. in molecular biology from New York University. She was an American Cancer Society Fellow at Rockefeller University in NYC in the department of biological chemistry. Dr. Tobia is the founder and president of MEG 21 with Supplamine and CEO of Dynamis Therapeutics, Inc. that was founded in 1997 based on a discovery made at Fox Chase Cancer Center. The scientists of Dynamis discovered chronic diseases and enzymes associated with aging. Dr. Tobia is part of several patent applications, which teach methods of treatment for inflammation and skin aging by inhibiting dermal 3DG.