Everything You Need to Know About Diabetes
Table of Contents
Diabetes is a group of disorders that are characterized by elevated blood sugar (glucose) levels, or hyperglycemia, in the body.
Glucose is the main source of energy for your brain, muscles, and tissues. After you eat, your body quickly breaks down carbohydrates into glucose, which triggers your pancreas to release the hormone insulin. Most of the body’s cells have insulin receptors, which interact with insulin to allow the entry of glucose into cells.
Diabetes results from flaws in insulin secretion from the pancreas, in insulin’s action upon cells, or both. And diabetes is a very common condition, with increasingly more individuals diagnosed every year.
The Centers for Disease Control and Prevention (CDC) estimates more than 100 million American adults are living with diabetes or prediabetes. Furthermore, nearly 25 percent of adults living with diabetes (approximately 7.2 million individuals) don’t know they have the condition – and only 11.6 percent of adults with prediabetes know they have it.
According to the American Diabetes Association (ADA), 1.25 million Americans (about 5 percent of all diagnosed cases) have type 1 diabetes. The lion’s share of cases – 90 to 95 percent – are type 2 diabetes. As a result, diabetes is the seventh leading cause of death in the United States.
Type 1 diabetes, which was previously called insulin-dependent diabetes, has several well-known risk factors, including family history, genetics, and age. You’re at increased risk for developing type 1 diabetes if you have a first-degree relative, like a parent or sibling, with the disease. The presence of certain genes can increase your risk of developing type 1 diabetes.
Additionally, the risk for type 1 diabetes increases in children who are 4 to 7 years old and between 10 and 14 years old.
There are several risk factors that increase your chances of developing type 2 diabetes, which was previously referred to as non-insulin-dependent diabetes. These factors include:
- Being overweight or obese.
- Being sedentary (little to no exercise).
- High blood pressure (hypertension).
- A family history of type 2 diabetes.
- Race (the condition is more common in African Americans, Hispanics, and American Indians).
- Age, if you’re older than 45 years old.
Family history, race, and age are considered unavoidable risk factors, while the others are considered avoidable risk factors. Overweight is defined as body mass index (BMI) of 25 to 29.9 (kg/m2), while a BMI ≥ 30 (kg/m2) is considered obese. You are at especially increased risk if your weight is centrally distributed (i.e., being “apple-shaped”).
In addition, a diagnosis of prediabetes or diabetes during pregnancy (known as gestational diabetes) puts you at increased risk for developing type 2 diabetes in the future.
Signs and Symptoms
The symptoms of diabetes are often insidious, but they can appear out of the blue. And regardless of the type of diabetes, the classic symptoms of this condition are actually similar.
Early symptoms of diabetes include frequent urination (polyuria), extreme thirst (polydipsia), and unexplained weight loss. Other symptoms of diabetes may include dry mouth, blurred vision, fatigue, hunger, and irritable behavior.
Two other worrisome symptoms of diabetes are persistent or recurrent infections, especially yeast infections, or wounds that are slow to heal.
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Screening and Prevention
Screening for type 1 diabetes is not recommended, but screening for type 2 diabetes is recommended by different organizations.
The U.S. Preventive Services Task Force (USPSTF) recommends screening for type 2 diabetes in individuals between 40 to 70 years of age who are overweight or obese. Doctors should also consider screening certain individuals who are at higher risk, like those with high blood pressure or a family history of diabetes.
The ADA recommends screening all adults 45 years or older regardless of risk for type 2 diabetes. Most authorities advise screening pregnant women for gestational diabetes if they have risk factors that could lead to the development of type 2 diabetes.
Prevention of diabetes centers around three factors: weight, diet, and exercise. If you have prediabetes and are overweight or obese, losing 5 to 7 percent of your body weight (or just 10 to 14 pounds) can lower your risk for developing type 2 diabetes. Most people can accomplish this with a low fat, high-fiber diet and regular physical activity. Regular physical activity recommendations are at least 30 minutes a day, five days a week (~150 minutes a week), which can be activities such as walking, running, swimming, or biking.
If you’re at very high risk for type 2 diabetes, your doctor may even consider prescribing medication for prevention.
When to See a Doctor
If you notice that you’re exhibiting any of the signs or symptoms of diabetes, it’s time to speak to a doctor. The symptoms of diabetes can appear mild or subtle at first – and the longer you wait to see a doctor, the worse those symptoms can become. It’s important to note any changes to your body.
See a doctor if you have any symptoms, such as frequent urination or extreme thirst, to pursue a diagnosis. If you’ve already been diagnosed with diabetes, make sure to continue communicating with and visiting your doctor, as this medical condition requires close follow-up and constant care.
The diagnosis of diabetes is straightforward. At your doctor’s appointment, they’ll want to know your symptoms, family history, medications, and allergies. You’ll also undergo a physical examination looking for any signs of diabetes. Finally, if your doctor has a high suspicion that you may have diabetes, blood tests will be ordered to screen for the presence of the disease.
There are four major tests that can be used to diagnose diabetes: fasting plasma glucose (FPG) test, glycated hemoglobin (A1C) test, random plasma glucose test, and oral glucose tolerance test (OGTT). Today, most individuals with type 2 diabetes are diagnosed with a FPG or A1C test. The OGTT is mostly used to diagnose gestational diabetes. The diagnosis of diabetes is confirmed with an abnormal test on more than one occasion.
The FPG test (also called the fasting blood sugar test) requires at least an 8-hour period of overnight fasting, or refraining from food or drink. A FPG less than 110 mg/dL is considered a normal fasting glucose. A FPG greater than or equal to 110 mg/dL, but less than 126 mg/dL is considered prediabetes. Lastly, a FPG greater than or equal 126 mg/dL suggests a diagnosis of diabetes.
The A1C test doesn’t require fasting and gives an indication of what your blood sugars have been over the last three months. An A1C less than 5.7 percent is considered normal, while an A1C between 5.7 and 6.4 percent indicates prediabetes. An A1C greater than or equal to 6.5 percent suggests diabetes.
The random plasma glucose test (also known as the random blood sugar test) requires no fasting and tests your blood sugar randomly. A random plasma glucose greater than or equal to 200 mg/dL, along with the symptoms of diabetes is highly suggestive of diabetes.
The OGTT requires at least an 8-hour fast and drinking a liquid containing 75 grams of glucose dissolved in water. First, your fasting blood sugar will be measured. Then, your blood sugar will be measured periodically for two hours after ingesting the sugary drink. A blood sugar less than or equal to 139 mg/dL 2 hours after the drink is considered normal, while a blood sugar between 140 and 199 mg/dL 2 hours after the drink is considered prediabetes. Lastly, a blood sugar greater than or equal to 200 mg/dL 2 hours after the drink is highly suggestive of diabetes.
Further specialized testing is sometimes recommended for type 1 diabetes. The American Association of Clinical Endocrinologists recommends routine confirmation of type 1 diabetes using autoantibody testing. Because it can be an autoimmune disease, testing may be used to detect autoimmune markers for one or more of the following autoantibodies: islet cells, insulin, glutamic acid decarboxylase, insulinoma-associated antigen-2, and zinc transporter. Autoimmune refers to the fact that your body mistakenly attacks its own tissues – in this case, the pancreatic cells responsible for the production of insulin.
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Types of Diabetes
Most doctors agree that there are three main types of diabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes.
Although it isn’t technically a type of diabetes, prediabetes deserves to be mentioned. Prediabetes refers to blood glucose levels that are higher than normal but not high enough to be diagnosed as frank diabetes. And prediabetes is potentially reversible with interventions such as diet, exercise, and sometimes even medication. The Mayo Clinic estimates that if you make no lifestyle changes with a diagnosis of prediabetes, you’re likely to develop type 2 diabetes within 10 years. The CDC estimates that 84 million Americans adults have prediabetes, with 90 percent going undiagnosed.
If you have type 1 diabetes, your pancreas doesn’t produce any insulin. It’s often considered an autoimmune disease, but it can be idiopathic – meaning it has no known cause. Type 1 diabetes accounts for about 5 percent of all cases of diabetes. The ADA estimates 40,000 people will be newly diagnosed with type 1 diabetes each year in the U.S. Contrary to popular belief, type 1 diabetes is not a childhood disease and can occur at any age.
If you have type 2 diabetes, your pancreas doesn’t make enough insulin, or your have enough insulin but your body can’t use it effectively. Type 2 diabetes is the most common type of diabetes, and it’s mostly attributable to insulin resistance, meaning your body becomes resistant to the actions of insulin. Remember, insulin allows glucose to enter cells and be utilized for energy. This resistance stimulates your pancreas to produce more insulin until it can no longer keep up with demand. As a result, the secretion of insulin decreases, leading to high blood sugar.
Gestational diabetes is diabetes that only occurs during pregnancy. It’s thought to be a consequence of the production of insulin-blocking hormones during pregnancy. Doctors most often test for it between 24 and 28 weeks of pregnancy. Gestational diabetes complicates approximately 4 percent of all pregnancies in the U.S. It also represents nearly 90 percent of all pregnancies complicated by diabetes.
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Generally, the complications of diabetes aren’t immediate – they develop over time. Having poorly controlled blood sugar levels increases your risk of serious health complications that can become life-threatening.
Chronic complications of diabetes may include:
- Blood vessel disease
- Eye disease
- Infection or skin conditions
- Nerve disease
- Kidney disease
- Amputations due to nerve damage or blood vessel disease.
Additionally, type 2 diabetes may also increase your risk of developing dementia, especially Alzheimer’s type.
Having diabetes dramatically increases your risk for cardiovascular disease. Individuals with diabetes are two times more likely to develop it, compared to individuals without diabetes. As a matter of fact, this is the leading cause of death among those with diabetes. You’re more likely to have narrowing of the arteries (atherosclerosis), which could lead to heart disease or heart attack and/or stroke. You’re also at increased risk for narrowing of the arteries in the legs, which is referred to as peripheral arterial disease (PAD).
Eye disease is a frequent complication of diabetes. The blood vessels of the retina are the most frequently damaged part of the eye in diabetics, and that damage is referred to as diabetic retinopathy. There are two major types of retinopathy: non-proliferative and proliferative. If you have diabetes, you’re also at increased risk for glaucoma and cataracts. Unfortunately, diabetic retinopathy is a significant cause of new-onset blindness.
If you have diabetes, you’re at increased for nerve damage. You may experience symptoms, such as tingling, numbness, burning sensations, or pain, in your fingers and toes. These symptoms typically spread, leading to loss of sensation, which puts you at increased risk for injury to your extremities. This loss of sensation can lead to infections that may ultimately require amputations of limbs, in part or in whole. Damage to the nerves governing digestion may lead to symptoms such as nausea, vomiting, diarrhea, or constipation.
Another frequent complication of diabetes is kidney disease. Your kidneys filter waste from your blood via millions of tiny blood vessels. High levels of blood sugar damage the delicate filtering system of the kidneys. Initially, you may not have any symptoms, except small amounts of protein in your urine (which doctors will usually check for periodically). As kidney damage progresses, large amounts of protein become evident in the urine, culminating in end-stage kidney failure that may require dialysis or kidney transplantation.
The complications of gestational diabetes also deserve mention. Gestational diabetes can not only affect an expectant mother’s health but also can affect the newborn’s health. It may increase the mother's risk of pre-eclampsia, or pregnancy-induced hypertension, a potentially life-threatening disease, and developing type 2 diabetes in the future. Gestational diabetes also increases your chances of needing a C-section, which increases the recovery time associated with childbirth and has potential surgical complications.
If you have gestational diabetes, your baby may be at increased risk for excessive birth weight (greater than 9 pounds), early (preterm) birth, low blood sugar (hypoglycemia), and breathing difficulties; all of which could result in a baby's death either before or shortly after birth.
Diabetes is a serious disease, and the cornerstones of its treatment are diet, exercise, and medication to control blood sugar levels in an effort to prevent and manage complications.
The disease requires a comprehensive, collaborative approach for optimal treatment. For example, you may have a primary care doctor, an endocrinologist, a nutritionist or dietician, and a neurologist caring for you.
Early initiation of medicines can improve blood sugar control and reduce long-term complications of diabetes. For individuals with type 1 diabetes and gestational diabetes, therapy with injected insulin is the primary means of treatment. For individuals with type 2 diabetes, treatment begins with oral medications and may progress to injectable insulin. If tolerated, all patients with type 2 diabetes should be treated with oral metformin (Glucophage), as it’s the only anti-diabetes medication that’s been shown in randomized controlled trials to reduce mortality and complications.
Other common classes of drugs, which can be used alone or in conjunction with metformin and/or insulin (short-, intermediate-, and long-acting) for the treatment of type 2 diabetes include thiazolidinediones (TZDs), dipeptidyl-peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and selective sodium-glucose transporter-2 (SGLT-2) inhibitors.
Other less commonly used classes of drugs for the treatment of type 2 diabetes include sulfonylureas, such as glyburide (DiaBeta), glipizide (Glucotrol), and glimepiride (Amaryl); alpha-glucosidase inhibitors, such as acarbose (Precose) and miglitol (Glyset); meglitinide derivatives, such as repaglinide (Prandin) and nateglinide (Starlix); the bile acid sequestrant colesevelam (Welchol); and the dopamine agonist bromocriptine (Cycloset). These medications are less commonly used for a number of reasons, including excessive cost, minimal effectiveness, and/or adverse side effects.
Living With Diabetes
If you’re one of the more than 30 million Americans living with diabetes, diet and exercise, along with medication, are key components of your treatment.
A balanced diet incorporating a variety of foods to optimize blood sugar levels can prevent or stabilize the complications of diabetes. You should be educated, by a dietician, about what foods are good for and what foods are bad for your diabetes.
Carbohydrates should be chosen wisely, as they can quickly raise blood sugar levels after being ingested. Complex carbohydrates, as opposed to simple carbohydrates, have no significant effect on blood sugar. Whole grains, such as brown rice, oatmeal, quinoa, millet, chia seeds, and amaranth, are examples of complex carbohydrates.
Dietary guidelines recommend at least 2.5 cups of vegetables per day, preferably fresh and eaten raw or lightly steamed, roasted, or grilled. Vegetables, in their natural state, are high in fiber, which helps to stabilize blood sugar levels. Eat them in a variety of colors, such as dark green, red, orange, yellow, and even purple.
Fruits contain essential vitamins, minerals, antioxidants, and fiber, but they tend to contain higher levels of carbohydrates and sugars than vegetables. Berries, cherries, kiwis, and pears are examples of blood sugar-friendly fruits.
Protein in the form of lean cuts of meat and poultry is a good choice for diabetics. There’s a multitude of choices, including beef, chicken, fish, pork, turkey, and seafood, and for those who want to avoid meat, beans, cheese, eggs, nuts, and tofu are alternative choices.
Exercise is another necessity for the management of diabetes. You should strive for 30 minutes per day most days of the week.
The combination of diet and exercise should lead to weight loss. If you have diabetes, it’s been shown that losing 5 to 10 percent of your body weight can provide significant improvements in blood sugar, blood pressure, and cholesterol. Before embarking on an exercise regimen, it is a good idea for you to consult a doctor.
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Today, diabetes is considered a dire public health issue that is intimately tied to the epidemic of obesity, especially in the case of type 2 diabetes. Intensified efforts at screening and prevention as well as early treatment with diet, exercise, and medications have the potential to significantly decrease the long-term complication rate of this serious disease.
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