Basics & Facts
Diabetes mellitus is a group of conditions where the level of sugar or glucose in the blood is too high. Glucose is very important for the functioning of your body and of your brain. There are several different types of diabetes; however, in all instances, having too much sugar in your blood can be very damaging to your body. Diabetes – and its complications – is the seventh leading cause of death in the United States, according to the CDC.
Types of Diabetes
Insulin is a hormone that is produced by your pancreas to help the cells in your body use glucose for fuel or to store excess glucose for future use. In diabetes, your body may have too little insulin or not use available insulin properly. There are two types of chronic diabetes as well as two potentially reversible diabetes conditions – prediabetes and gestational diabetes.
Type 1 Diabetes
In type 1 diabetes, the body’s immune system — which typically fights off foreign bacteria and viruses — attacks and destroys the cells in the pancreas that produce insulin. As a result, your body is unable to produce enough insulin; since insulin is needed for your cells to utilize the sugar in your blood, the sugar just builds up in the bloodstream. Type 1 diabetes is more common in children, teenagers and young adults, but can be diagnosed at any age. It accounts for 5 percent of all diagnosed cases of diabetes, according to the CDC. Scientists believe that type 1 may be caused by genetics or some environmental exposure although the exact mechanism is not understood.
Type 2 Diabetes
According to the CDC, this type of diabetes is the most common type, as about 90 to 95 percent of all diabetes cases are type 2 cases. In this type of diabetes, your cells become resistant to the insulin in your body no matter how much insulin your pancreas makes. This leads to an increase in the levels of sugar in your blood. Genetics and environment probably play a role in the development of this disease as well. Being overweight may also play a role in developing type 2, but not everyone with type 2 is overweight.
Most people who develop type 2 diabetes often have some changes in their blood glucose levels before an actual diagnosis. Their blood glucose levels are higher than normal, but not high enough to be diagnosed as type 2 diabetes. Some research suggests that there may be some long-term damage to different parts of the body, like the heart, that may be going on during the period of prediabetes. Having prediabetes does not guarantee that you will go on to develop diabetes though, as only 15 to 30 percent of people go on to develop type 2 diabetes within five years, according to the CDC. There are lifestyle interventions you can do to prevent the progression.
Some women who do not already have diabetes develop elevated levels of blood glucose during pregnancy. The placenta secretes hormones that make the cells more resistant to insulin; as the pregnancy progresses, more and more of these hormones are released. Usually the pancreas just compensates by increasing the amount of insulin it secretes; however, this doesn’t always work. For many women, this situation reverses itself after the baby is born, but a research by the Canadian Medical Association suggests that around 19 percent of women may be at higher risk of developing type 2 diabetes outside of pregnancy later.
Your symptoms with either type 1, type 2 or gestational diabetes may vary depending on how high your sugar levels actually are. Symptoms for type 1 include:
- Increased urination: A lot of sugar in the blood causes you to urinate more often which leads to increased thirst
- Increased thirst
- Excess hunger
- Unexplained weight loss
- Abdominal pain
- Loss of menstruation
Usually people with type 1 diabetes are very sick when they visit the doctor because their blood sugar levels are extremely high.
People who have prediabetes and type 2 diabetes often do not have symptoms because the condition develops gradually. Type 2 symptoms can include:
- Frequent infections
- Wounds that heal slowly
- Blurry vision
If your blood sugar levels are extremely high, type 2 diabetes may present more like type 1:
- Increased urination and thirst
Another symptom is elevated ketone (products from the breakdown of muscle and fat) or sugar levels in your urine; however, you may not notice that one on your own. Your physician may find these results on a urine test.
The risk factors differ for each type of diabetes.
- Type 1 Diabetes
- Family history of type 1 diabetes
- A child of an older mother
- Mother who had pre-eclampsia during pregnancy, a condition where the blood pressure goes up dangerously high
- History of viral infections during childhood
- Family history of autoimmune diseases
- Northern European or Mediterranean descent
- Prediabetes and Type 2 Diabetes
- Family history of type 2 diabetes
- Older than 45 years of age
- African American, Hispanic American or Native American descent
- Excess body fat
- Sedentary lifestyle
- High blood pressure
- High cholesterol and/or triglyceride levels
- History of gestational diabetes or polycystic ovary syndrome
- Gestational Diabetes
- 25 years and older
- Family history of type 2 diabetes
- Personal history of prediabetes or gestational diabetes
- Overweight before pregnancy
- African American, Hispanic, Native American, Asian, or Pacific Islander descent
There may be some short-term complications that may develop if your blood sugar levels are not monitored appropriately.
- Hyperglycemia or high blood sugar: You may need to adjust your diet, medications or both. Call your doctor for assistance.
- Diabetic ketoacidosis: Your body may start breaking down too much fat to meet its energy needs; this produces ketones which can be measured in your urine. You will have vomiting, weakness, nausea, fever, stomach pain and a sweet odor in your breath. This condition requires emergency care and is more common in type 1 diabetes.
- Hyperglycemic hyperosmolar nonketotic syndrome: This life-threatening condition occurs when your blood sugar levels are over 600 mg/dL, as the blood becomes thick with the excess sugar. Symptoms are extreme thirst, fever, confusion, hallucinations, vision loss, dry mouth and drowsiness. This is more common in type 2 diabetes and also requires emergency care.
- Hypoglycemia (low blood sugar): If your blood sugar drops too low, you may experience shakiness, weakness, sweating, hunger, fainting and seizures. You need some glucose that can be quickly absorbed like fruit juice or glucose tablets.
Diabetes can cause significant long-term complications if you do not manage your blood sugar levels appropriately. These complications can include:
- Cardiovascular disease: Diabetes increases your risk of developing heart disease including coronary heart disease, heart attack and stroke.
- Kidney damage (nephropathy): Diabetes can damage the blood vessels in the kidneys; significant damage can lead to end-stage kidney disease and a need for dialysis or a transplant.
- Eye damage: Diabetes also damages the blood vessels in the back of the eye (retina) which leads to retinopathy. This can lead to blindness. Diabetes also includes your risk of developing cataracts and glaucoma too.
- Nerve damage: Damage to the blood vessels that supply the nerves of your body – especially your legs and feet – can lead to nerve problems (neuropathy) such as tingling, burning and numbness. If not treated, this can progress to loss of feeling in the extremities. If the nerves that control digestion are affected, you may suffer from constipation, nausea, vomiting or diarrhea. Men may develop erectile dysfunction if the nerves that supply the penis are impacted.
- Foot damage: If the nerves that affect the feet are damaged, you are at risk for significant complications. You may not heal properly after an injury which could then move on to an ulcer or become infected. At this point, you may be at risk of needing an amputation.
- Skin problems: You may develop infections of the skin – including the gums — more easily.
- Osteoporosis: Diabetes increases your risk of developing osteoporosis over time.
For pregnant women with gestational diabetes, there are some potential complications as well.
- The extra sugar that crosses the placenta increases your baby’s growth. Your baby may become really large and require a C-section.
- This is an increased risk of premature delivery
- Health complications for baby such as low blood sugar, jaundice or breathing problems are more likely.
- Death is more common in these babies.
The mothers may develop pre-eclampsia and is at risk for gestational diabetes with subsequent pregnancies.
The diagnosis of diabetes usually takes more than one test to firmly establish the diagnosis. A physical examination does not make the call. Here are some signs you may have diabetes:
- A urine test shows high levels of sugar in your urine or
- If your blood sugar level is greater than 200 mg/dL,
Your physician may order further testing to see if you may have diabetes. To confirm the diagnosis, one or more other tests need to be completed.
These tests include:
- Hemoglobin A1C: This is a blood test. A normal result is less than 5.7 percent; pre-diabetes is 5.7 to 6.4 percent; and diabetes is 6.5 percent or higher. This test may also be used after you have been diagnosed to assess how well you have been managing your blood sugar levels.
- Fasting blood glucose level: This is another blood test. If the results are higher than 126 mg/dL twice, a diagnosis of diabetes is made. If the level is between 100 – 126, that is considered prediabetes or an impaired fasting glucose.
- Oral glucose tolerance test: You are given a glucose drink. If your blood sugar level is greater than 200 mg/dL two hours later, you are diagnosed with diabetes.
People who should be screened for type 2 diabetes:
- Overweight children
- Overweight adults with a BMI greater than 25
- Adults over age 45
Pregnant women usually get tested for gestational diabetes between 24 and 28 weeks of pregnancy. If you are high risk, your doctor may test you sooner.
- Initial glucose challenge test: You will get a syrupy sugar drink. If your blood sugar level is below 130-140 mg/dL after one hour, this is considered normal. If it is higher, you may need further follow-up.
- Follow-up testing: You have to fast overnight and have your blood sugar levels tested. You then will receive another sugary drink – one that is more concentrated – and your blood levels will be checked every hour for three hours. If two of those measurements are higher than normal, you will be diagnosed with gestational diabetes.
Treatment & Management
No matter what type of diabetes you have, the goal is to keep your blood sugar levels as normal as possible. Research has shown that people who do this suffer fewer complications. In order to achieve this goal, you will need to monitor your blood sugar levels and manage your diet and weight.
Some of the first changes you will have to make will be lifestyle alterations.
- Diet: You will have to switch to a healthy, low-fat diet that focuses on grains, fruits and vegetables. Making these changes can be challenging so you should consider getting some assistance from a registered dietitian. If you have type 1 diabetes, you will need to learn how to carbohydrate count as carbohydrates affect blood sugar levels the most. You will have to monitor your carbohydrate intake to make sure you give yourself the right amount of insulin.
- Exercise: It is important to be physically active in all types of diabetes. Exercise can help lower your blood sugar levels by forcing cells to consume the sugar and by making the cells more sensitive to insulin. Talk to your physician about the types of exercise that are appropriate for you. Try to incorporate a favorite exercise into your daily life every day.
- Weight loss: If you have type 2 diabetes, you may have to lose weight to get into a more healthy range. Weight loss may increase your cells’ sensitivity to insulin so you may not need as much medication, if any.
- ID: You need to wear an ID tag or bracelet is you have type 1 or type 2 diabetes. If you are unable to speak for yourself, this information may influence the way that a paramedic or ER doctor may treat you. You also need to let family and friends know just in case you have an episode of low blood sugar so they can help you.
- Regular doctor appointments: You need to visit your general practitioner at least every year outside of your regular diabetes check-ups. This doctor can help you keep your blood pressure and cholesterol levels in check. You also should see the eye doctor at least once a year to rule out any retinopathy. You should also see your dentist at least once a year and be sure to brush and flush every day.
- Immunizations: Your shots should be up-to-date and you may need to get others like the pneumonia vaccine and the hepatitis B vaccine.
- Foot care: Because of the problems that diabetes can cause with feet, you should take care of yours. Keep them clean and inspect them regularly to make sure there are no non-healing injuries that you should alert your physician to. You also should keep your nails trimmed neatly or have a podiatrist do it.
- Stop smoking: If you can’t, get your doctor to help.
- Drink responsibly.
Type 1 diabetes treatment will include the use of insulin – through either insulin shots or an insulin pump. This will go in hand with carbohydrate counting.
Type 2 diabetes may require oral medications, insulin or both. With both forms, you will have to monitor your blood sugar levels several times a day to stay within your target range and give yourself extra medicine if needed.
Gestational diabetes usually requires a healthy diet, exercise, blood sugar monitoring and perhaps insulin.
Diabetes medications include:
- Insulin: Almost all type 1 diabetes and some type 2 diabetes use replacement insulin. It can be injected with a syringe, a pen or an insulin pump. There are several types of insulin:
- Rapid-acting begins to work five minutes after injection, has its peak action in one hour, and continues to work for two to four hours.
- Short-acting begins to work 30 minutes after injection, has its peak action two to three hours later and continues to work for three to six hours.
- Intermediate-acting begins to work two to four hours after injection, has its peak action four to 12 hours later and continues to work for 12 to 18 hours.
- Long-acting begins to work six to 10 hours after injection and usually work for 24 hours.
Your doctor will often prescribe a combination of types of insulin to best manage your blood sugar needs. Premixed insulin is also available that may contain two different types of insulin to help you manage your levels.
- Oral or other medications: Some oral medications (sulfonylureas, meglitinides) cause your pancreas to release more insulin. Other medications (biguanides, thiazolidinediones) block the production of glucose by the liver meaning you need less insulin to manage your glucose levels. Some medications block the breakdown of carbohydrates (alpha-glucosidase inhibitors) or prevent the breakdown of enzymes (DPP-4 inhibitors). DPP-4 inhibitors may be injected or taken by mouth.
For type 1 diabetics, a pancreas transplant may be a treatment option. If it works, you would not need any more supplementation insulin. But because of the risks of transplant, this option is usually reserved for people whose disease cannot be controlled any other way.
Type 2 diabetics may need assistance with weight loss. Weight loss surgery like gastric bypass surgery may be beneficial if their BMI is above 35.
You may also need other surgical procedures to manage various complications like heart surgery, eye surgery or amputations depending on your situation.
While there have been some encouraging findings with alternative treatments, no alternative therapies have been recommended for the treatment of diabetes because there has not been any consistent findings. Some therapies that have been interesting in helping control blood sugar levels include:
Don’t take one of these therapies without speaking to your physician first. These substances may interfere with the medications that you are already taking. You also should not stop taking your prescribed medications without further instructions.
Other alternative therapies like acupuncture or relaxation therapies may also play a role. Acupuncture may help people who have neuropathy pain who have had no success from other conventional therapies. Relaxation techniques can help relieve stress which may help your condition overall. Again, speak to your doctor before adding any of these therapies to your regimen.
Research is ongoing in trying to figure out how to prevent the development of diabetes. For people with type 1 diabetes, these factors are still elusive. However, it may be possible to prevent the development of type 2 diabetes in some people. Regular physical activity, a healthy diet and weight loss may help prevent type 2 diabetes. Different organizations are developing lifestyle interventions to help obese or overweight people who are at high-risk of developing diabetes.
Diabetes is a complex condition and can be frustrating. It can also be time-consuming and confusing, so you may need support from your doctor, nurse, dietitian or a support group. It is difficult to manage your diabetes totally alone. Getting support can help you more effectively deal with your condition. With dedication and support, you can lead a full, productive life with diabetes.
- University of Maryland Medical Center: Diabetes
- U.S. National Library of Medicine
- American Diabetes Association: Diabetes Basics
- American Diabetes Association: Prediabetes
- American Diabetes Association: Prevention
- American Diabetes Association: What Are My Options
- American Diabetes Association: Living With Diabetes
- CDC: Diabetes Public Health Resource
- CDC: Diabetes Health Concerns
- CDC: Prediabetes
- Mayo Clinic – Entire Diabetes Section
- March of Dimes: Gestational Diabetes