Diabetes Overview

Diabetes

What Is Diabetes

Diabetes is a disease that affects your body’s ability to regulate blood glucose (sugar) levels. There are several types of diabetes:

Type 1 diabetes. Previously referred to as juvenile diabetes because of its tendency to develop during childhood or adolescence, type 1 diabetes can actually develop at any age. In type 1 diabetes, the body does not produce enough insulin, a hormone that allows for the movement of sugar (food) into the body’s cells, resulting in dangerously high levels of glucose in the blood that the body cannot convert into energy. This is thought to be caused by the body’s immune cells mistakenly attacking and destroying the insulin-producing islet cells of the pancreas, though research on the exact cause is still ongoing. The Juvenile Diabetes Research Foundation reports that as many as three million American have type 1 diabetes. The number of children diagnosed with type 1 diabetes in the U.S. each year is more than 15,000. Of the people in the U.S. who are living with type 1 diabetes, 85% are adults and 15% are children. The prevalence of type 1 diabetes in children and teens between 2001 and 2009 increased by 23%.

Type 2 diabetes. Type 2 diabetes typically develops later in life, which is why it was once referred to as adult-onset diabetes. It is thought to be caused by either insufficient insulin production (like type 1 diabetes) or by the body resisting the effects of insulin. Without proper treatment, patients with type 2 diabetes suffer the side effects of high blood sugar, like fatigue and increased hunger, thirst, and urination. According to the Centers for Disease Control, one in 10 American adults has type 2 diabetes. For people 65 and older, the rate is one in four. An estimated seven million people with type 2 diabetes are undiagnosed. From 2008 to 2009, 22% of American children and teens were reported to have type 2 diabetes. Type 2 diabetes is a growing health concern in America. The American Diabetes Association reports that the prevalence of diagnosed diabetes in the U.S. increased by 128% from 1988 to 2008, and it is estimated that 1 in 3 Americans will have type 2 diabetes by 2050.

Gestational diabetes. Gestational diabetes is caused by hormonal changes during pregnancy that make the body more insulin intolerable. If left untreated, gestational diabetes can cause serious complications for both mother and child. It typically develops around 24 weeks and goes away after giving birth, though women with gestational diabetes are at a higher risk for developing type 2 diabetes. According to the Centers for Disease Control, reported rates of gestational diabetes range from 2% to 10% of pregnancies. In most cases, symptoms of gestational diabetes disappear immediately after pregnancy – only 5 to 10% of women with gestational diabetes remain diabetic (typically type 2 diabetics). However, gestational diabetes does raise the risk of developing diabetes in later years. Women who have had gestational diabetes have a 35% to 60% chance of developing diabetes in the next 10–20 years. Recently implemented diagnostic criteria for gestational diabetes will increase the proportion of women diagnosed with gestational diabetes. Using these new diagnostic criteria, an international, multi-center study of gestational diabetes found that gestational diabetes actually affects 18% of pregnancies.

What Causes Diabetes

Risk Factors For Diabetes

The risk factors for the developing diabetes differ from type to type. Below are the possible risk factors for each type of diabetes:

Type 1 diabetes:

Family history. Anyone with a parent or sibling with type 1 diabetes has a slightly increased risk of developing the condition. Research done at the University of Michigan and published in the June 2014 issue of the journal Cell found that a defect in Clec16a, a gene responsible for getting rid of old mitochondria (the powerhouses of cells), disrupts the ability of beta cells to produce insulin, resulting in type 1 diabetes.
Environmental Factors. In 2006, an international team of scientists formed a research effort called The Environmental Determinants of Diabetes in the Young (TEDDY), which has centers in four countries and screens a total of 50,000 children a year. However, the reasons for the environmental triggers have still not been definitively established.
Viral exposure. Exposure to Epstein-Barr virus, Coxsackie virus, mumps virus, or cytomegalovirus may trigger the disease, as they are all connected to other auto-immune disorders.
Geography. The incidence of type 1 diabetes tends to increase as you travel away from the equator . According to the Mayo Clinic, type 1 diabetes is more common in European countries than in African or South American countries. Finland has the highest rate of type 1 diabetes in the world. No scientific reason for this phenomenon has been established but some researchers theorize that there is a connection between type 1 diabetes and cold weather.
Consuming certain foods as an infant. Early introduction of both cow’s milk and cereal to a baby’s diet may increase the risk of type 1 diabetes. A Finnish review of the literature regarding infant feeding, published in the American Journal of Clinical Nutrition in 2010 reported contradictory data about early introduction of cow’s milk proteins contained in infant formulas. Some surveys have indicated that early introduction of cow’s milk increases the risk of type 1 diabetes whereas others have shown no association at all. As for wheat, a study done at the University of Colorado and published in JAMA in 2003 found that children initially exposed to cereals between the ages 0 and 3 months had a higher risk of developing type 1 diabetes compared with those who were exposed during the fourth through sixth months. Both gluten-containing and non-gluten-containing cereals conferred the increased risk.
Having a mother younger than age 25 when she gave birth to you.
Having a mother who had preeclampsia during pregnancy. Preeclampsia is a condition involving high blood pressure and protein in the urine that develop after the 20th week of pregnancy. The connection to diabetes is unknown.
Being born with jaundice
Having a respiratory infection just after birth

Type 2 Diabetes:

Being overweight. The more fatty tissue you have, the more resistant your cells become to insulin. A study done by scientists at the Tokyo Medical and Dental University and published in July 2010 in the Journal of Leukocyte Biology found that obesity is associated with a state of chronic, low-grade inflammation that may lead to insulin resistance.
Belly fat. If your body stores fat primarily in your abdomen, your risk of type 2 diabetes is higher than if your body stores fat elsewhere. The Japanese study cited above also found that visceral (belly) fat obesity contributes to the development of the metabolic syndrome, which can lead to diabetes.
Sitting still. Being physically active helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin. Conversely, the less active you are, the greater your risk of type 2 diabetes. Being inactive is an even greater risk for women than it is for men. A study done at the University of Leicester in the UK and published in the March 2012 issue of the American Journal of Preventive Medicine found that women who are sedentary for most of the day are more likely than men to exhibit the early metabolic defects that act as a precursor to developing type 2 diabetes than people who tend to sit less. The researchers could not pinpoint why there was a gender difference, although the team was suggested that women might snack more often than men during sedentary behavior, or that men tend to take part in more robust activity when are not sitting.
Family history. The risk of type 2 diabetes increases if your parent or sibling has type 2 diabetes. As of 2007, researchers had identified 10 genetic variants that are associated with type 2 diabetes. In 2014, a team of scientists at the University of Michigan School of Public Health discovered additional genetic regions linked to type 2 diabetes. The team notes that the findings may lead to new treatments for the disease. The genes implicated in type 2 diabetes are IGF2BP2, CDKAL1, TCF7L2, SLC30A8, HHEX, FTO, PPARG, KCNJ11, ARL15, and RREB1, among others under investigation. If both parents have diabetes, a child’s risk of developing diabetes is nearly 50%.
Race. Blacks, Hispanics, American Indians and Asian-Americans are more likely to develop type 2 diabetes than whites are. The reason that different ethnic groups have different rates of diabetes has not been established, but the most recent data from the Centers for Disease Control show that 7.6% of non-Hispanic whites have diabetes compared to 9.0% of Asian Americans; 12.8% of Hispanics; 13.2% of non-Hispanic blacks; 15.9% of American Indians/Alaskan Natives.
Age. The risk of type 2 diabetes increases as you get older, especially after age 45. The most recent data from the Centers for Disease Control showed that although the prevalence of diabetes in 2012 for the population in general was 9.3%, the prevalence in Americans age 65 and older was 25.9%.
Pre-diabetes. This is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as diabetes. If untreated, it’s likely to progress to type 2 diabetes. The CDC reports that inn 2012, 37% of Americans were diagnosed with pre-diabetes and that the rate for those older than 65 was 51%.
Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of later developing type 2 diabetes increases. According to the National Diabetes Education Program, immediately after pregnancy 5 to 10 percent of women who had gestational diabetes have diabetes. NDEP also reports that all women with a history of gestational diabetes have a 35% to 60% chance of developing diabetes within 10 to 20 years after giving birth
Giving birth to a high birth weight baby. You are more likely to develop type 2 diabetes if you gave birth to a baby weighing more than 9 pounds (4 kilograms )

Diagnosing Diabetes

Diabetes can be diagnosed by measuring blood glucose levels. Consistently high blood glucose levels, combined with symptoms of fatigue, excessive thirst, and frequent urination indicate the lack of insulin and/or insulin resistance associated with diabetes.

The following tests can be used to determine blood glucose levels:

Fasting blood glucose level test—Fasting blood glucose level tests measure a person’s blood glucose level after eight hours of not eating or drinking. According to the American Diabetes Association, normal fasting blood glucose is 70-100 mg/dL (3.9-5.6 mmol/L). Diabetes is typically diagnosed if blood glucose levels are higher than 126 mg/dL in two separate readings. Because of the fasting component of the test, fasting blood glucose level tests are usually scheduled in the morning, Because it is able to collect a blood glucose level without the variable of it being affected by a sugary meal or drink, fasting blood glucose levels are often used to make suspicions of diabetes definite. The test is usually scheduled in the morning to help ensure a complete fast beforehand.
Random (nonfasting) blood glucose level test—Nonfasting blood glucose level tests are taken right after eating. The normal blood glucose level after eating a meal is less than 180 mg/dL (10mmol/L) Blood glucose levels higher than 200 mg/dL can be signs of type 2 diabetes, however this must be confirmed with a fasting test. Results of random blood glucose level tests are largely dependent on what was last eaten and when.
Oral glucose tolerance test—During this test, an initial sample of blood is taken before the patient is asked to drink a solution containing glucose (typically 75 grams). Blood is then taken every 30 to 60 minutes after consuming the solution for up to three hours, recording the rate at which glucose is broken down by the body. Diabetes is diagnosed if the glucose level is higher than 200 mg/dL.
Hemoglobin A1c test —The hemoglobin A1c test can be used to diagnose diabetes as well as gauge how well someone is managing their diabetes over the course of 2-3 months. A1c is a component of hemoglobin that glucose is able to stick to as it carried throughout the blood stream. With a higher percentage of A1c, the blood is able to retain more glucose. During the Hemoglobin A1c test, blood is drawn either at a lab or through a finger prick at a general physician’s office, and tested for the percentage of hemoglobin A1c. This shows the average level of blood sugar (glucose) over the previous three months, indicating whether or not you properly digest glucose, and, if you do have diabetes, how well you are controlling your condition. Normal levels of A1c are around 4.5 – 6%, and individuals with levels of 6.5% and higher are typically diabetic. Levels of 7.5% and higher can be indicative of poorly controlled diabetes. Like many other of the diagnostic tests, it is best performed on two separate occasions to rule out any sugary meal or drink interference.
Ketone test—Your body breaks down fat and creates substances called ketones if you are not consuming sufficient carbohydrates to supply your body with glucose or if you don’t metabolize glucose correctly. Ketones can be toxic A ketone test can be done using a urine or blood sample. It is used when the following warning signs or conditions warrant the confirmation or ruling out of a complication called diabetic ketoacidosis:
- When the blood sugar is higher than 240 mg/dL
- During an illness such as pneumonia, heart attack, or stroke
- When nausea or vomiting occur
- During pregnancy

Symptoms of Diabetes

Prognosis

Living With Diabetes

When you maintain a healthy lifestyle, you are helping to control your diabetes.

Here are eight tips for living well with diabetes:

Test your blood sugar. Monitoring blood sugar levels can help you understand your body’s needs at different times of the day. Depending on your levels, you may need to adjust your physical activity, meals, or insulin treatment.
Keep a food diary. It’s important to keep your body weight and blood sugar under control. Details such as what time you ate, how hungry you are before and after you eat, and what foods you choose, can help you learn to eat a healthy diet and understand how certain foods affect your blood glucose levels.
Quit smoking. Diabetes symptoms and complications are worse for smokers than nonsmokers. According to the Centers for Disease Control, smokers are 30–40% more likely to develop type 2 diabetes than nonsmokers. The CDC also reports that people with diabetes who smoke are more likely than nonsmokers to have trouble with insulin dosing and with controlling their disease. In addition, smokers with diabetes have higher risks for serious complications, including heart and kidney disease, poor blood flow in the legs and feet that can lead to amputation, retinopathy (an eye disease that can cause blindness), peripheral neuropathy (damaged nerves to the arms and legs that causes numbness, pain, weakness, and poor coordination)
Limit alcohol. If you are a heavy drinker, it’s a good idea to cut down or even stop drinking, as alcohol contains a large amount of sugar that can disrupt blood glucose levels.
Maintain healthy teeth and gums. Diabetes may lead to higher levels of glucose in your saliva, which puts you at a higher risk for tooth decay and gum disease. To keep your teeth and gums healthy, brush at least three times a day, floss daily, and make regular visits to your dentist for examinations and cleanings.
Take good care of your feet. Some people with diabetes get tingling or numbness in their feet due to nerve damage, called neuropathy. That is why it is important to take good care of your feet. Wash your feet daily and wear clean, dry socks throughout the day. Always wear something on your feet to protect them from cuts or bruises, even inside the house. Check your feet every day to make sure there are no blisters, swelling, or other problems. Discuss any foot problems you may have with your doctor or podiatrist.
Exercise regularly and with care. Exercise is important to help maintain a healthy weight, regulate blood sugar levels, and boost your mood. However, diabetics might experience complications like increased susceptibility to infection and gangrene after an injury, or hypoglycemia (low blood glucose), so it’s important to take the proper precautions. Wear comfortable footwear and socks to prevent damage to the feet, drink plenty of water to keep your body hydrated, keep an eye on the temperature and amount of sun exposure, and carry your glucose pills and monitor with you in case of hypoglycemia during or after exercise.
Get your eyes examined every year. Prolonged and inadequate blood glucose control can damage and weaken the small blood vessels in the retina.

Screening

Prevention

Medication And Treatment

The treatment for diabetes can vary from type to type. Below are the main medications for each type of diabetes:

Type 1 Diabetes

Insulin is the primary medication used to treat type 1 diabetes. Up until the 1980s, medical grade insulin was made from purified pig or cow insulin. Today, medical grade insulin is made in laboratories using genetic recombinant technology to allow pancreatic cells in laboratory cultures to produce insulin.

There are four different types of insulin that can be taken. These are:

Rapid-acting (Humalog, Novolog, Apidra): begins to work after 15 minutes, peaks in 30 to 90 minutes, and has a duration of three to four hours.
Short-acting (Humulin R, Velosulin – for use with a pump): begins to work in 30 to 60 minutes, peaks in two to three hours, and has a duration of three to six hours.
Intermediate-acting (NPH): begins to work in 90 minutes to six hours, peaks in four to 14 hours, and has a duration of up to 24 hours.
Long-acting (Lantus, Levernir): begins to work in six to 14 hours and remains effective for 24 to 36 hours.

Insulin is administered by injection several times throughout the day so that it can avoid the digestive enzymes of the stomach, which would otherwise destroy it.

Insulin injections come in the form of:

Syringe and vial. When insulin injections are done properly, most people find that they are relatively painless. Insulin is usually given as a subcutaneous injection, meaning that the needle is inserted into the fat layer between the skin and the muscle and deposits the insulin there.
Insulin pens look like an old-fashioned cartridge pen, except that it is disposable, has a needle, and holds a pre-filled cartridge of insulin. Pens are particularly useful for people who travel frequently, whose coordination is impaired, or those who have visual difficulties. They are also more useful for people who require very small doses of insulin.
Pump. This is a computerized device about the size of a beeper that is worn on the belt or in a pocket. It delivers a steady, measured dose of insulin through a flexible plastic tube called a cannula. With the aid of a small needle, the cannula is inserted through the skin, usually in the abdominal region, and is taped in place. In some products, the needle is removed and only a soft catheter remains in place. Pumps can deliver very precise insulin doses for different times of the day.
Symlin (pramlintide), is an injectable medication that is always used in combination with insulin and never alone. Symlin is a synthetic version of the body’s natural amylin, a peptide hormone co-secreted with insulin by the pancreas. Symlin is used to control high blood sugar that can occur after meals.

Type 2 Diabetes:

If diet and exercise do not help keep your blood sugar at normal or near-normal levels, your doctor may prescribe medication. Since these drugs help lower your blood sugar levels in different ways, your doctor may have you take more than one drug.

Here, from the American Diabetes Association web site, are the ADAs definitions of the types of medications used to treat diabetes:

Sulfonylureas. These stimulate the beta cells of the pancreas to release more insulin. Sulfonylurea drugs have been in use since the 1950s. Chlorpropamide (Diabinese) is the only first-generation sulfonylurea still in use today. The second-generation sulfonylureas are used in smaller doses than the first-generation drugs. There are three second-generation drugs: glipizide (Glucotrol and Glucotrol XL), glyburide (Micronase, Glynase, and Diabeta), and glimepiride (Amaryl). These drugs are generally taken one to two times a day, before meals. All sulfonylurea drugs have similar effects on blood glucose levels, but they differ in side effects, how often they are taken, and interactions with other drugs.
Biguanides. Metformin (Glucophage) is a biguanide. Biguanides lower blood glucose levels primarily by decreasing the amount of glucose produced by the liver. Metformin also helps to lower blood glucose levels by making muscle tissue more sensitive to insulin so glucose can be absorbed. It is usually taken two times a day. A side effect of metformin may be diarrhea, but this is improved when the drug is taken with food.
Meglitinides. These are drugs that also stimulate the beta cells to release insulin. Repaglinide (Prandin) and nateglinide (Starlix) are meglitinides. They are taken before each of three meals.
Thiazolidinediones. Rosiglitazone (Avandia) and pioglitazone (ACTOS) are in a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and also reduce glucose production in the liver. The first drug in this group, troglitazone (Rezulin), was removed from the market because it caused serious liver problems in a small number of people. So far rosiglitazone and pioglitazone have not shown the same problems, but users are still monitored closely for liver problems as a precaution. Both drugs appear to increase the risk for heart failure in some individuals, and there is debate about whether rosiglitazone may contribute to an increased risk for heart attacks. Both drugs are effective at reducing A1C and generally have few side effects.
DPP-4 Inhibitors. A new class of medications called DPP-4 inhibitors help improve A1C without causing hypoglycemia. They work by preventing the breakdown of a naturally occurring compound in the body, GLP-1. GLP-1 reduces blood glucose levels in the body, but is broken down very quickly so it does not work well when injected as a drug itself. By interfering in the process that breaks down GLP-1, DPP-4 inhibitors allow it to remain active in the body longer, lowering blood glucose levels only when they are elevated. DPP-4 inhibitors do not tend to cause weight gain and tend to have a neutral or positive effect on cholesterol levels. Sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina) are the DPP-4 inhibitors currently on the market in the US.
SGLT2 Inhibitors. Glucose in the bloodstream passes through the kidneys, where it can either be excreted or reabsorbed. Sodium-glucose transporter 2 (SGLT2) works in the kidney to reabsorb glucose, and a new class of medication, SGLT2 inhibitors, blocks this action, causing excess glucose to be eliminated in the urine. Canagliflozin (Invokana) and dapagliflozin (Farxiga) are SGLT2 inhibitors that have recently been approved by the FDA to treat type 2 diabetes. Because they increase glucose levels in the urine, side effects can include urinary tract and yeast infections.
Alpha-glucosidase inhibitors. Acarbose (Precose) and meglitol (Glyset) are alpha-glucosidase inhibitors. These drugs help the body to lower blood glucose levels by blocking the breakdown of starches, such as bread, potatoes, and pasta in the intestine. They also slow the breakdown of some sugars, such as table sugar. Their action slows the rise in blood glucose levels after a meal. They should be taken with the first bite of a meal. These drugs may have side effects, including gas and diarrhea.
Bile Acid Sequestrants. The bile acid sequestrant (BAS) colesevelam (Welchol) is a cholesterol-lowering medication that also reduces blood glucose levels in patients with diabetes. BASs help remove cholesterol from the body, particularly LDL cholesterol, which is often elevated in people with diabetes. The medications reduce LDL cholesterol by binding with bile acids in the digestive system; the body in turn uses cholesterol to replace the bile acids, which lowers cholesterol levels. The mechanism by which colesevelam lowers glucose levels is not well understood. Because BASs are not absorbed into the bloodstream, they are usually safe for use by patients who may not be able to use other medications because of liver problems. Because of the way they work, side effects of BASs can include flatulence and constipation.
Oral combination therapy Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together. For example, a biguanide and a sulfonylurea may be used together. Many combinations can be used. Though taking more than one drug can be more costly and can increase the risk of side effects, combining oral medications can improve blood glucose control when taking only a single pill does not have the desired effects. Switching from one single pill to another is not as effective as adding another type of diabetes medicine.

If blood sugar cannot be controlled by any of the above medicines, insulin injections may be necessary.

Gestational Diabetes

According to the Mayo Clinic, between 10 and 20 percent of women with gestational diabetes need insulin. In addition, some physicians prescribe an oral blood sugar control medication (see the list above). However, other doctors feel that not enough research has been done to confirm that oral drugs are as safe and as effective as injectable insulin for pregnant women with gestational diabetes. If your doctor prescribes an oral medication, you may want to consider getting a second opinion.

Many people with diabetes use combinations of medications and insulin to better control and manage their condition. Your physician and the other members of your care team will help determine what is best for you.

Diabetes

What Is Diabetes

What Causes Diabetes

Risk Factors For Diabetes

Diagnosing Diabetes

Symptoms of Diabetes

Prognosis

Living With Diabetes

Screening

Prevention

Medication And Treatment

Complementary and Alternative Treatment

Care Guide

When To Contact A Doctor

Questions For Your Doctor

Questions For A Doctor

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