DIABETES

What is diabetes?
●​ Diabetes is a condition that happens when your blood sugar (glucose) is too high. It
develops when your pancreas doesn’t make enough insulin or any at all, or when your
body isn’t responding to the effects of insulin properly. Diabetes affects people of all
ages. Most forms of diabetes are chronic (lifelong), and all forms are manageable with
medications and/or lifestyle changes.

Glucose (sugar) mainly comes from carbohydrates in your food and drinks. It’s your
body’s go-to source of energy. Your blood carries glucose to all your body’s cells to use
for energy.

When glucose is in your bloodstream, it needs help — a “key” — to reach its final
destination. This key is insulin (a hormone). If your pancreas isn’t making enough insulin
or your body isn’t using it properly, glucose builds up in your bloodstream, causing high
blood sugar (hyperglycemia).
Over time, having consistently high blood glucose can cause health problems, such as
heart disease, nerve damage and eye issues.

The technical name for diabetes is diabetes mellitus. Another condition shares the term
“diabetes” — diabetes insipidus — but they’re distinct. They share the name “diabetes”
because they both cause increased thirst and frequent urination. Diabetes insipidus is
much rarer than diabetes mellitus.

What are the types of diabetes?

●​ Type 2 diabetes: With this type, your body doesn’t make enough insulin and/or your
body’s cells don’t respond normally to the insulin (insulin resistance). This is the most
common type of diabetes. It mainly affects adults, but children can have it as well. You
may not have any symptoms at all, or you may not notice them since they develop
slowly. Routine bloodwork may show a high blood sugar level before you recognize
symptoms. Another possible sign of prediabetes is darkened skin on certain parts of your
body (acanthosis nigricans).
●​ Prediabetes: This type is the stage before Type 2 diabetes. Your blood glucose levels
are higher than normal but not high enough to be officially diagnosed with Type 2
diabetes.
●​ Type 1 diabetes: This type is an autoimmune disease in which your immune system
attacks and destroys insulin-producing cells in your pancreas for unknown reasons. Up
to 10% of people who have diabetes have Type 1. It’s usually diagnosed in children and
young adults, but it can develop at any age. Symptoms of T1D can develop quickly —
over a few weeks or months. You may develop additional symptoms that are signs of a
severe complication called diabetes-related ketoacidosis (DKA). DKA is life-threatening
 and requires immediate medical treatment. DKA symptoms include vomiting, stomach
pains, fruity-smelling breath and labored breathing.

●​ Gestational diabetes: This type develops in some people during pregnancy.

Gestational diabetes usually goes away after pregnancy. However, if you have
gestational diabetes, you’re at a higher risk of developing Type 2 diabetes later in life. ou
typically won’t notice symptoms of gestational diabetes. Your healthcare provider will test
you for gestational diabetes between 24 and 28 weeks of pregnancy.

Other types of diabetes include:

●​ Type 3c diabetes: This form of diabetes happens when your pancreas

experiences damage (other than autoimmune damage), which affects its ability to
produce insulin. Pancreatitis, pancreatic cancer, cystic fibrosis and
hemochromatosis can all lead to pancreas damage that causes diabetes. Having
your pancreas removed (pancreatectomy) also results in Type 3c.
●​ Latent autoimmune diabetes in adults (LADA): Like Type 1 diabetes, LADA
also results from an autoimmune reaction, but it develops much more slowly than
Type 1. People diagnosed with LADA are usually over the age of 30.
●​ Maturity-onset diabetes of the young (MODY): MODY, also called monogenic
diabetes, happens due to an inherited genetic mutation that affects how your
body makes and uses insulin. There are currently over 10 different types of
MODY. It affects up to 5% of people with diabetes and commonly runs in families.
●​ Neonatal diabetes: This is a rare form of diabetes that occurs within the first six
months of life. It’s also a form of monogenic diabetes. About 50% of babies with
neonatal diabetes have the lifelong form called permanent neonatal diabetes
mellitus. For the other half, the condition disappears within a few months from
onset, but it can come back later in life. This is called transient neonatal diabetes
mellitus.
●​ Brittle diabetes: Brittle diabetes is a form of Type 1 diabetes that’s marked by
frequent and severe episodes of high and low blood sugar levels. This instability
often leads to hospitalization. In rare cases, a pancreas transplant may be
necessary to permanently treat brittle diabetes.

How common is diabetes?

●​ Diabetes is common. Approximately 37.3 million people in the United States have
diabetes, which is about 11% of the population. Type 2 diabetes is the most
common form, representing 90% to 95% of all diabetes cases.

●​ About 537 million adults across the world have diabetes. Experts predict this
number will rise to 643 million by 2030 and 783 million by 2045.
Symptoms and Causes
Symptoms of diabetes include:

●​ Increased thirst (polydipsia) and dry mouth.

●​ Frequent urination.
●​ Fatigue.
●​ Blurred vision.
●​ Unexplained weight loss.
●​ Numbness or tingling in your hands or feet.
●​ Slow-healing sores or cuts.
●​ Frequent skin and/or vaginal yeast infections.

What causes diabetes?

●​ Too much glucose circulating in your bloodstream causes diabetes, regardless of the
type. However, the reason why your blood glucose levels are high differs depending on
the type of diabetes.

●​ Insulin resistance: Type 2 diabetes mainly results from insulin resistance. Insulin
resistance happens when cells in your muscles, fat and liver don’t respond as they
should to insulin. Several factors and conditions contribute to varying degrees of insulin
resistance, including obesity, lack of physical activity, diet, hormonal imbalances,
genetics and certain medications.
●​ Autoimmune disease: Type 1 diabetes and LADA happen when your immune system
attacks the insulin-producing cells in your pancreas.
●​ Hormonal imbalances: During pregnancy, the placenta releases hormones that cause
insulin resistance. You may develop gestational diabetes if your pancreas can’t produce
enough insulin to overcome the insulin resistance. Other hormone-related conditions like
acromegaly and Cushing syndrome can also cause Type 2 diabetes.
●​ Pancreatic damage: Physical damage to your pancreas — from a condition, surgery or
injury — can impact its ability to make insulin, resulting in Type 3c diabetes.
●​ Genetic mutations: Certain genetic mutations can cause MODY and neonatal diabetes

Long-term diabetes complications

●​ .Blood glucose levels that remain high for too long can damage your body’s tissues and
organs. This is mainly due to damage to your blood vessels and nerves, which support
your body’s tissues.

Cardiovascular (heart and blood vessel) issues are the most common type of long-term
diabetes complication. They include:
●​ Coronary artery disease.
 ●​ Heart attack.
●​ Stroke.
●​ Atherosclerosis.
●​
Other diabetes complications include:
●​
●​ Nerve damage (neuropathy), which can cause numbness, tingling and/or pain.
●​ Nephropathy, which can lead to kidney failure or the need for dialysis or transplant.
●​ Retinopathy, which can lead to blindness.
●​ Diabetes-related foot conditions.
●​ Skin infections.
●​ Amputations.
●​ Sexual dysfunction due to nerve and blood vessel damage, such as erectile dysfunction
or vaginal dryness.
●​ Gastroparesis.
●​ Hearing loss.
●​ Oral health issues, such as gum (periodontal) disease.

Diagnosis and Tests

Healthcare providers diagnose diabetes by checking your glucose level in a blood test. Three
tests can measure your blood glucose level:

●​ Fasting blood glucose test: For this test, you don’t eat or drink anything except water
(fast) for at least eight hours before the test. As food can greatly affect blood sugar, this
test allows your provider to see your baseline blood sugar.
●​ Random blood glucose test: “Random” means that you can get this test at any time,
regardless of if you’ve fasted.
●​ A1c: This test, also called HbA1C or glycated hemoglobin test, provides your average
blood glucose level over the past two to three months.

Management and Treatment

The four main aspects of managing diabetes include:

●​ Blood sugar monitoring: Monitoring your blood sugar (glucose) is key to determining
how well your current treatment plan is working. It gives you information on how to
manage your diabetes on a daily — and sometimes even hourly — basis. You can
monitor your levels with frequent checks with a glucose meter and finger stick and/or
with a continuous glucose monitor (CGM). You and your healthcare provider will
determine the best blood sugar range for you.
●​ Oral diabetes medications: Oral diabetes medications (taken by mouth) help manage
blood sugar levels in people who have diabetes but still produce some insulin — mainly
 people with Type 2 diabetes and prediabetes. People with gestational diabetes may also
need oral medication. There are several different types. Metformin is the most common.
●​ Insulin: People with Type 1 diabetes need to inject synthetic insulin to live and manage
diabetes. Some people with Type 2 diabetes also require insulin. There are several
different types of synthetic insulin. They each start to work at different speeds and last in
your body for different lengths of time. The four main ways you can take insulin include
injectable insulin with a syringe (shot), insulin pens, insulin pumps and rapid-acting
inhaled insulin.
●​ Diet: Meal planning and choosing a healthy diet for you are key aspects of diabetes
management, as food greatly impacts blood sugar. If you take insulin, counting carbs in
the food and drinks you consume is a large part of management. The amount of carbs
you eat determines how much insulin you need at meals. Healthy eating habits can also
help you manage your weight and reduce your heart disease risk.
●​ Exercise: Physical activity increases insulin sensitivity (and helps reduce insulin
resistance), so regular exercise is an important part of management for all people with
diabetes.

Due to the increased risk for heart disease, it’s also important to maintain a healthy:

●​ Weight.
●​ Blood pressure.
●​ Cholesterol.

Prevention
●​ Eat a healthy diet, such as the Mediterranean diet.
●​ Get physically active. Aim for 30 minutes a day at least five days a week.
●​ Work to achieve a weight that’s healthy for you.
●​ Manage your stress.
●​ Limit alcohol intake.
●​ Get adequate sleep (typically 7 to 9 hours) and seek treatment for sleep disorders.
●​ Quit smoking.
●​ Take medications as directed by your healthcare provider to manage existing risk factors
for heart disease.