Diabetes is not a single illness but rather a range of diseases in which the body either does not create enough insulin or cannot use insulin properly.
Insulin is a hormone that moves glucose (a simple sugar) from the bloodstream into the cells for energy and storage.
Without enough insulin, blood sugar rises. Having hypertension, sugar for an extended period can harm blood vessels, nerves, and organs such as the kidneys, eyes, and heart.
Just under 10 percent of Americans have diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Most of them have type 2 diabetes. Hence symptoms usually do not appear until the disease is advanced; more than 1 in 4 people with this condition do not know they have it.
TYPES OF DIABETES
Type 1 diabetes is an autoimmune disease: the immune system attacks and damages insulin-producing cells in the pancreas.
Without insulin, glucose cannot move from the bloodstream into the cells.
In type two diabetes, the pancreas can still create insulin. However, the body’s cells become resistant to the effects of this hormone.
Increasingly more significant amounts of insulin are needed to move glucose into the cells.
Eventually, the pancreas can become damaged from producing enough insulin to meet the body’s needs.
The phase at which blood sugar levels are high but not yet high enough for a diagnosis of diabetes is called prediabetes.
Gestational diabetes is a high level of blood sugar during pregnancy. Usually, gestational diabetes will go away once the baby is born.
However, it can increase the mother’s risk of developing type 2 diabetes later in life.
The precise source of type 1 diabetes is not fully understood. A combination of genes and environmental factors may be involved.
Researchers think a virus may trigger the condition in susceptible people.
Type 1 diabetes used to be colloquially called juvenile diabetes because it usually affected children, whereas type 2 was found mainly in adults.
Due to rising obesity rates, it is common for type 2 diabetes to start during childhood.
Obesity and inactivity are significant risks for type 2 diabetes. Fat tissue is more resistant to the effects of insulin than other types of tissue.
However, not everyone with type 2 diabetes is overweight. Genes, increasing age, and other factors are also involved.
Gestational diabetes is caused by hormones the placenta produces, making the mother’s cells more resistant to insulin.
Obesity in the mother and a family history of diabetes are other contributing factors.
Symptoms of type 1 diabetes typically come on quickly. Type 2 diabetes may take decades to progress to the point where symptoms are noticeable.
The following are symptoms of both type 1 and type 2 diabetes:
- increased thirst and hunger
- frequent urination
- unexplained weight loss
- blurred vision
- numbness or tingling in the hands or feet
- sores that are slow to heal
- urinary tract infections and other types of infections
Testing is done for type 1 diabetes in people with symptoms or those who have a family history of the condition.
Doctors recommend testing type 2 diabetes in people ages 45 and older and those ages 19 to 44 who are overweight or obese.
Testing is also endorsed for women who have had gestational diabetes.
A fasting blood glucose test diagnoses both type 1 and type 2 diabetes. A fasting blood sugar level of 100 to 125 milligrams per deciliter (mg/dL) is considered prediabetes. A grade of 126 mg/dL or more is diabetes.
(OGTT) an oral glucose tolerance test procedure measures your blood sugar level after you fast overnight and then drink a sweet liquid. A grade of 200 mg/dL or more indicates diabetes.
The A1C blood test provides a snapshot of your blood glucose levels over three months. This test can be used both to diagnose diabetes and to monitor its treatment.
A1C is measured as a percentage. An A1C stage of 6.5 percent or above indicates diabetes.
Another way to diagnose type 1 diabetes is to test the urine for ketones—a substance produced when the body breaks down fat.
People who don’t make enough insulin have to use fat for energy.
Another test looks for the presence of autoantibodies—antibodies that the body produces against its tissue in autoimmune diseases.
Child-bearing women are routinely screened for gestational diabetes with a glucose challenge test during their second trimester of pregnancy.
This test includes drinking a sugary solution and then getting a blood sugar test an hour ater.
Cure for both types one and two diabetes involves combining lifestyle interventions like diet, food, exercise, and medications to control blood sugar levels.
People with prediabetes who exercise and lose about 7 percent of their body weight may prevent the onset of the disease.
Having diabetes requires you to check your blood sugar, sometimes several times a day. You will need to adjust your diet and insulin or medication dose according to your blood sugar levels.
Individuals with type 1 diabetes will need to take a synthetic form of insulin to balance for what their body no longer produces. Insulin comes in several states.
Rapid-acting insulin goes to work quickly, but the effects only last for a few hours. Long-acting forms take several hours to start working, but their effects last for a day or more.
Insulin can be delivered manually through a syringe or pen or continuously via a pump that attaches to the skin.
An artificial pancreas is a relatively new device that automatically tests blood sugar levels and delivers insulin through a pump.
Persons with type 2 diabetes may need to take other medications by mouth or injection to manage their blood sugar levels.
Some medicines stimulate the pancreas to produce more insulin. Others help the body use insulin more efficiently or slow the release of glucose from the liver, so the body requires less insulin.
When diabetes is not well controlled over time, it can lead to severe consequences. The most common complications include
- Heart attack, stroke, narrowing of the arteries (atherosclerosis)
- Kidney failure or end-stage kidney disease
- Diabetic retinopathy, cataracts, glaucoma, blindness
- Nerve pain, numbness, tingling, burning, or loss of sensation, particularly in the arms, legs, hands, and feet
- Infections of the feet which may eventually lead to amputations
- Bacterial and fungal skin infections
Gestational diabetes can lead to problems in the baby, such as a larger than average size at birth and an increased risk for type 2 diabetes later in life.
The mother is also more likely to develop type 2 diabetes in the future.
“Diabetes.” Mayo Clinic. August 8, 2018. https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444 (accessed October 24, 2019).
“Diabetes in Children and Teens.” MedlinePlus. September 11, 2019. https://medlineplus.gov/diabetesinchildrenandteens.html (accessed October 24, 2019).
“Diabetes Mellitus: An Overview.” Cleveland Clinic. October 2, 2018. https://my.clevelandclinic.org/health/diseases/7104-diabetes-mellitus-an-overview (accessed October 24, 2019.).
“What is Diabetes?” National Institute of Diabetes and Digestive and Kidney Diseases. December 2016. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes (accessed October 24, 2019).
American Diabetes Association, 2451 Crystal Drive, Suite 900, Arlington, VA, 22202, (800) 342-2383, http://www.diabetes.org.
Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215, (617) 309-2400, https://www.joslin.org.