Type 2 diabetes used to be called adult-onset diabetes or non-insulin dependent diabetes because it was diagnosed mainly in adults who did not require insulin to manage their condition. However, because more children are starting to be diagnosed with T2D, and insulin is used more frequently to help manage type 2 diabetes, referring to the condition as “adult-onset” or “non-insulin dependent” is no longer accurate.
Adult and pediatric endocrinologists, specialists in treating hormone imbalances and disorders of the endocrine system, are experts in helping patients with diabetes manage their disease. People with the disease also may be cared for by a number of primary care providers including family or internal medicine practitioners, naturopathic doctors, or nurse practitioners. When complications arise, these patients often consult other specialists, including neurologists, gastroenterologists, ophthalmologists, acupuncturists, surgeons, and cardiologists. Nutritionists, integrative and functional medicine doctors, and physical activity experts such as personal trainers are also important members of a diabetes treatment team. It is important to interview a new health care professional about their experience, expertise, and credentials to make sure they are well qualified to help you.
Diabetes that's triggered by pregnancy is called gestational diabetes (pregnancy, to some degree, leads to insulin resistance). It is often diagnosed in middle or late pregnancy. Because high blood sugar levels in a mother are circulated through the placenta to the baby, gestational diabetes must be controlled to protect the baby's growth and development.
Diabetes insipidus is characterized by excessive urination and thirst, as well as a general feeling of weakness. While these can also be symptoms of diabetes mellitus, if you have diabetes insipidus your blood sugar levels will be normal and no sugar present in your urine. Diabetes insipidus is a problem of fluid balance caused by a problem with the kidneys, where they can't stop the excretion of water. Polyuria (excessive urine) and polydipsia (excessive thirst) occur in diabetes mellitus as a reaction to high blood sugar.
A study by Dabelea et al found that in teenagers and young adults in whom diabetes mellitus had been diagnosed during childhood or adolescence, diabetes-related complications and comorbidities—including diabetic kidney disease, retinopathy, and peripheral neuropathy (but not arterial stiffness or hypertension)—were more prevalent in those with type 2 diabetes than in those with type 1 disease. 
The classic presenting symptoms of type 1 diabetes mellitus are discussed below. For some children, the first symptoms of diabetes mellitus are those of diabetic ketoacidosis. This is a serious and life-threatening condition, requiring immediate treatment. Ketoacidosis occurs due to a severe disturbance in the body’s metabolism. Without insulin, glucose cannot be taken up into cells. Instead fats are broken down for energy which can have acid by-products.
Type 2 diabetes usually has a slower onset and can often go undiagnosed. But many people do have symptoms like extreme thirst and frequent urination. Other signs include sores that won't heal, frequent infections (including vaginal infections in some women), and changes in vision. Some patients actually go to the doctor with symptoms resulting from the complications of diabetes, like tingling in the feet (neuropathy) or vision loss (retinopathy), without knowing they have the disease. This is why screening people at risk for diabetes is so important. The best way to avoid complications is to get blood glucose under control before
These diabetes complications are related to blood vessel diseases and are generally classified into small vessel disease, such as those involving the eyes, kidneys and nerves (microvascular disease), and large vessel disease involving the heart and blood vessels (macrovascular disease). Diabetes accelerates hardening of the arteries (atherosclerosis) of the larger blood vessels, leading to coronary heart disease (angina or heart attack), strokes, and pain in the lower extremities because of lack of blood supply (claudication).
Type 2 diabetes is a preventable disease that affects more than 9 percent of the U.S. population, or about 29 million people. According to the Centers for Disease Control and Prevention, more than a quarter — some 8 million people — remain undiagnosed. With complications including nerve damage, kidney damage, poor blood circulation, and even death, it’s important for us all to know the early signs of type 2 diabetes.
observations The onset of type 1 diabetes mellitus is sudden in children. Type 2 diabetes often begins insidiously. Characteristically the course is progressive and includes polyuria, polydipsia, weight loss, polyphagia, hyperglycemia, and glycosuria. The eyes, kidneys, nervous system, skin, and circulatory system may be affected by the long-term complications of either type of diabetes; infections are common; and atherosclerosis often develops. In type 1 diabetes mellitus, when no endogenous insulin is being secreted, ketoacidosis is a constant danger. The diagnosis is confirmed by fasting plasma glucose and history.
Type 1 diabetes has some connection to your family genes, but that doesn't mean you'll get it if one of your parents had it. "Since not all identical twins get diabetes, we do think that exposure to an additional environmental factor may trigger an immune response that ultimately causes destruction of the insulin-producing cells of the pancreas," says Dr. Sarah R. Rettinger, an endocrinologist with Providence Saint John's Health Center in Santa Monica, California.
^ Jump up to: a b c d Inzucchi, SE; Bergenstal, RM; Buse, JB; Diamant, M; Ferrannini, E; Nauck, M; Peters, AL; Tsapas, A; Wender, R; Matthews, DR (March 2015). "Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes". Diabetologia. 58 (3): 429–42. doi:10.1007/s00125-014-3460-0. PMID 25583541.
Hypoglycemia, or low blood sugar, can be caused by too much insulin, too little food (or eating too late to coincide with the action of the insulin), alcohol consumption, or increased exercise. A patient with symptoms of hypoglycemia may be hungry, cranky, confused, and tired. The patient may become sweaty and shaky. Left untreated, the patient can lose consciousness or have a seizure. This condition is sometimes called an insulin reaction and should be treated by giving the patient something sweet to eat or drink like a candy, sugar cubes, juice, or another high sugar snack.
What his theory boils down to is that type 2 diabetes is caused not by extra fat alone, but by fat stored in the wrong places. "Virtually all the individuals [with insulin resistance] have fat accumulation in liver and muscle," Shulman says, where it may disrupt normal biological processes, leading to insulin resistance. "If you can understand this, you can ideally come up with new ways to prevent insulin resistance and type 2 diabetes."
Diabetes is a condition in which the body cannot properly store and use fuel for energy. The body's main fuel is a form of sugar called glucose, which comes from food (after it has been broken down). Glucose enters the blood and is used by cells for energy. To use glucose, the body needs a hormone called insulin that's made by the pancreas. Insulin is important because it allows glucose to leave the blood and enter the body's cells.
Elevated homocysteine levels in the blood called hyperhomocysteinemia, is a sign that the body isn't producing enough of the amino acid homocysteine. is a rare and serious condition that may be inherited (genetic). People with homocystinuria die at an early age. Symptoms of hyperhomocysteinemia include developmental delays, osteoporosis, blood clots, heart attack, heart disease, stroke, and visual abnormalities.
People with Type 1 diabetes are usually totally dependent on insulin injections for survival. Such people require daily administration of insulin. The majority of people suffering from diabetes have the Type 2 form. Although they do not depend on insulin for survival, about one third of sufferers needs insulin for reducing their blood glucose levels.
Diabetic peripheral neuropathy is a condition where nerve endings, particularly in the legs and feet, become less sensitive. Diabetic foot ulcers are a particular problem since the patient does not feel the pain of a blister, callous, or other minor injury. Poor blood circulation in the legs and feet contribute to delayed wound healing. The inability to sense pain along with the complications of delayed wound healing can result in minor injuries, blisters, or callouses becoming infected and difficult to treat. In cases of severe infection, the infected tissue begins to break down and rot away. The most serious consequence of this condition is the need for amputation of toes, feet, or legs due to severe infection.
We give you special kudos for managing your condition, as it is not always easy. If you've had diabetes for a long time, it's normal to burn out sometimes. You may get tired of your day to day tasks, such as counting carbohydrates or measuring your blood sugar. Lean on a loved one or a friend for support, or consider talking to someone else who has diabetes who can provide, perhaps, an even more understanding ear or ideas that can help you.
Women seem to be at a greater risk as do certain ethnic groups, such as South Asians, Pacific Islanders, Latinos, and Native Americans. This may be due to enhanced sensitivity to a Western lifestyle in certain ethnic groups. Traditionally considered a disease of adults, type 2 diabetes is increasingly diagnosed in children in parallel with rising obesity rates. Type 2 diabetes is now diagnosed as frequently as type 1 diabetes in teenagers in the United States.
Environmental factors are important, because even identical twins have only a 30-60% concordance for type 1 diabetes mellitus and because incidence rates vary in genetically similar populations under different living conditions.  No single factor has been identified, but infections and diet are considered the 2 most likely environmental candidates.
Test Your Blood Sugar: Blood sugar testing is an important part of helping to manage your diabetes. Whether you choose to do selective blood sugar testing or test your blood sugar at the same times daily, blood sugar testing gives you another piece of information and can help you change your diet and adjust your fitness routine or medicines. Keeping your blood sugars at target will help to reduce diabetes complications.
The food that people eat provides the body with glucose, which is used by the cells as a source of energy. If insulin isn't available or doesn't work correctly to move glucose from the blood into cells, glucose will stay in the blood. High blood glucose levels are toxic, and cells that don't get glucose are lacking the fuel they need to function properly.
Every cell in the human body needs energy in order to function. The body's primary energy source is glucose, a simple sugar resulting from the digestion of foods containing carbohydrates (sugars and starches). Glucose from the digested food circulates in the blood as a ready energy source for any cells that need it. Insulin is a hormone or chemical produced by cells in the pancreas, an organ located behind the stomach. Insulin bonds to a receptor site on the outside of cell and acts like a key to open a doorway into the cell through which glucose can enter. Some of the glucose can be converted to concentrated energy sources like glycogen or fatty acids and saved for later use. When there is not enough insulin produced or when the doorway no longer recognizes the insulin key, glucose stays in the blood rather entering the cells.
Sources of processed or added sugar, including condiments, honey, and especially sugary drinks, are just a few of the potential culprits for weight gain, Grieger says, and it’s when they’re consumed in excess that they can contribute to diabetes risk. “The largest source of added sugar comes from sweetened beverages. They run the gamut of soda, sweetened tea, juices with added sugar, sports drinks — it’s a plethora. Just about everything we drink has added sugar in it, except for water,” she explains.
Part of a treatment plan for diabetes will involve learning about diabetes, how to manage it, and how to prevent complications. Your doctor, diabetes educator, or other health care professional will help you learn what you need to know so you are able to manage your diabetes as effectively as possible. Keep in mind that learning about diabetes and its treatment will take time. Involving family members or other people who are significant in your life can also help you manage your diabetes.
In type 1 diabetes (formerly called insulin-dependent diabetes or juvenile-onset diabetes), the body's immune system attacks the insulin-producing cells of the pancreas, and more than 90% of them are permanently destroyed. The pancreas, therefore, produces little or no insulin. Only about 5 to 10% of all people with diabetes have type 1 disease. Most people who have type 1 diabetes develop the disease before age 30, although it can develop later in life.
The definition of a genetic disease is a disorder or condition caused by abnormalities in a person's genome. Some types of genetic inheritance include single inheritance, including cystic fibrosis, sickle cell anemia, Marfan syndrome, and hemochromatosis. Other types of genetic diseases include multifactorial inheritance. Still other types of genetic diseases include chromosome abnormalities (for example, Turner syndrome, and Klinefelter syndrome), and mitochondrial inheritance (for example, epilepsy and dementia).
Insulin-dependent diabetes mellitus is believed to result from autoimmune, environmental, and/or genetic factors. Whatever the cause, the end result is destruction of insulin-producing pancreatic beta cells, a dramatic decrease in the secretion of insulin, and hyperglycemia. Non-insulin-dependent diabetes mellitus is presumably heterogeneous in origin. It is associated with older age, obesity, a family history of diabetes, and ethnicity (genetic components). The vast majority of those with non-insulin-dependent diabetes are overweight Kahn (2003). This form of the disorder has a much slower rate of progression than insulin-dependent diabetes. Over time the ability to respond to insulin decreases, resulting in increased levels of blood glucose. The pancreatic secretion of insulin increases in an attempt to compensate for the elevated levels of glucose. If the condition is untreated, the pancreatic production of insulin decreases and may even cease.
Nerve damage from diabetes is called diabetic neuropathy and is also caused by disease of small blood vessels. In essence, the blood flow to the nerves is limited, leaving the nerves without blood flow, and they get damaged or die as a result (a term known as ischemia). Symptoms of diabetic nerve damage include numbness, burning, and aching of the feet and lower extremities. When the nerve disease causes a complete loss of sensation in the feet, patients may not be aware of injuries to the feet, and fail to properly protect them. Shoes or other protection should be worn as much as possible. Seemingly minor skin injuries should be attended to promptly to avoid serious infections. Because of poor blood circulation, diabetic foot injuries may not heal. Sometimes, minor foot injuries can lead to serious infection, ulcers, and even gangrene, necessitating surgical amputation of toes, feet, and other infected parts.
While this can produce different types of complications, good blood sugar control efforts can help to prevent them. This relies heavily on lifestyle modifications such as weight loss, dietary changes, exercise and, in some cases, medication. But, depending on your age, weight, blood sugar level, and how long you've had diabetes, you may not need a prescription right away. Treatment must be tailored to you and, though finding the perfect combination may take a little time, it can help you live a healthy, normal life with diabetes.
Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst.
For example, the environmental trigger may be a virus or chemical toxin that upsets the normal function of the immune system. This may lead to the body’s immune system attacking itself. The normal beta cells in the pancreas may be attacked and destroyed. When approximately 90% of the beta cells are destroyed, symptoms of diabetes mellitus begin to appear. The exact cause and sequence is not fully understood but investigation and research into the disease continues.
Glucose is a simple sugar found in food. Glucose is an essential nutrient that provides energy for the proper functioning of the body cells. Carbohydrates are broken down in the small intestine and the glucose in digested food is then absorbed by the intestinal cells into the bloodstream, and is carried by the bloodstream to all the cells in the body where it is utilized. However, glucose cannot enter the cells alone and needs insulin to aid in its transport into the cells. Without insulin, the cells become starved of glucose energy despite the presence of abundant glucose in the bloodstream. In certain types of diabetes, the cells' inability to utilize glucose gives rise to the ironic situation of "starvation in the midst of plenty". The abundant, unutilized glucose is wastefully excreted in the urine.
When you have Type 2 diabetes, you may start out with something called insulin resistance. This means your cells do not respond well to the insulin you are making. "Insulin levels may be quite high, especially in the early stages of the disease. Eventually, your pancreas may not be able to keep up, and insulin secretion goes down," Rettinger explains. Insulin resistance becomes more common as you put on more weight, especially weight around your belly.
Insulin is released into the blood by beta cells (β-cells), found in the islets of Langerhans in the pancreas, in response to rising levels of blood glucose, typically after eating. Insulin is used by about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, for conversion to other needed molecules, or for storage. Lower glucose levels result in decreased insulin release from the beta cells and in the breakdown of glycogen to glucose. This process is mainly controlled by the hormone glucagon, which acts in the opposite manner to insulin.
Poorly controlled diabetic patients are at risk for numerous oral complications such as periodontal disease, salivary gland dysfunction, infection, neuropathy, and poor healing. None of these complications are unique to diabetes. However, their presence may serve as an early clue to the possible presence of diabetes, prompting your dentist to perform or request further testing.
A: There are two scenarios to consider here, pregnant patients who have diabetes and pregnant patients who have gestational diabetes. Gestational diabetes describes hyperglycemia discovered during pregnancy. This hyperglycemia often corrects itself after pregnancy, but women who experience gestational diabetes are at higher for developing type-2 diabetes later in life when compared to women who experience no hyperglycemia during pregnancy. Regardless of the type of diabetes a pregnant patient has, her physician will closely monitor her disease and its response to therapy. Proper glucose control is important not only for the health of the mother, but also her developing child.
Hypoglycemia. Hypoglycemia or “insulin shock” is a common concern in DM management. It typically develops when a diabetic patient takes his or her normal dose of insulin without eating normally. As a result, the administered insulin can push the blood sugar to potentially dangerously low levels. Initially the patient may experience, sweating, nervousness, hunger and weakness. If the hypoglycemic patient is not promptly given sugar (sugar, cola, cake icing), he or she may lose consciousness and even lapse into coma. Questions and Answers about Diabetes and Your Mouth Q: If I have diabetes, will I develop the oral complications that were mentioned? A: It depends. There is a two-way relationship between your oral health and how well your blood sugar is controlled (glycemic control). Poor control of your blood sugar increases your risk of developing the multitude of complications associated with diabetes, including oral complications. Conversely, poor oral health interferes with proper glucose stabilization. Indeed, recent research has shown that diabetic patients who improve their oral health experience a modest improvement in their blood sugar levels. In essence, “Healthy mouths mean healthy bodies.” Q: What are the complications of diabetes therapy that can impact my oral health? A: One of the most worrisome urgent complications associated with diabetes management is the previously described hypoglycemia or insulin shock. In addition, many of the medications prescribed to treat diabetes and its complications, such as hypertension and heart disease, may induce adverse side effects affecting the mouth. Common side effects include dry mouth, taste aberrations, and mouth sores. Q: I have type-2 diabetes. Are my dental problems different than those experienced by people with type-1 diabetes? A: No. All patients with diabetes are at increased risk for the development of dental disease. What is different is that type-2 disease tends to progress more slowly than type-1 disease. Thus, most type-2 diabetes patients are diagnosed later in life, a time in which they are likely to already have existing dental problems. Remember, there is no dental disease unique to diabetes. Uncontrolled or poorly controlled diabetes simply compromises your body’s ability to control the existing disease.
Our bodies break down the foods we eat into glucose and other nutrients we need, which are then absorbed into the bloodstream from the gastrointestinal tract. The glucose level in the blood rises after a meal and triggers the pancreas to make the hormone insulin and release it into the bloodstream. But in people with diabetes, the body either can't make or can't respond to insulin properly.
Previously, CGMs required frequent calibration with fingerstick glucose testing. Also their results were not accurate enough so that people always had to do a fingerstick to verify a reading on their CGM before calculating a dose of insulin (for example before meals or to correct a high blood sugar). However, recent technological advances have improved CGMs. One professional CGM can be worn for up to 14 days without calibration. Another personal CGM can be used to guide insulin dosing without confirmation by fingerstick glucose. Finally, there are now systems in which the CGM device communicates with insulin pumps to either stop delivery of insulin when blood glucose is dropping (threshold suspend), or to give daily insulin (hybrid closed loop system).
A second theory, dubbed the hygiene hypothesis, blames the rise of type 1 on a society that's too clean. Good housekeeping and hygiene habits mean far fewer interactions with germs, which in turn may foster an immune system prone to going awry. "In a developing country, you have more infectious disease. This is associated with a lower risk of type 1 diabetes," says Li Wen, MD, PhD, an immunologist at the Yale University School of Medicine. In her lab, rodents raised in hyper-clean environments are more likely to get type 1 than those reared in dirtier cages.
Although this newfound knowledge on sugar, and specifically added sugar, may prompt you to ditch the soda, juice, and processed foods, be mindful of the other factors that can similarly influence your risk for type 2 diabetes. Obesity, a family history of diabetes, a personal history of heart disease, and depression, for instance, are other predictors for the disease, according to the NIH.
At the same time that the body is trying to get rid of glucose from the blood, the cells are starving for glucose and sending signals to the body to eat more food, thus making patients extremely hungry. To provide energy for the starving cells, the body also tries to convert fats and proteins to glucose. The breakdown of fats and proteins for energy causes acid compounds called ketones to form in the blood. Ketones also will be excreted in the urine. As ketones build up in the blood, a condition called ketoacidosis can occur. This condition can be life threatening if left untreated, leading to coma and death.
Diabetes insipidus is considered very rare in less 20,000 cases diagnosed per year. Diabetes mellitus is more common, with type 2 diabetes being more common than type 1. There are more than 3 million cases of type 2 diabetes. Unlike diabetes mellitus, diabetes insipidus is not treated by controlling insulin levels. Depending on your symptoms, your doctor may prescribe a low-salt diet, hormone therapy, or have you increase your water intake.
Jump up ^ O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Kushner FG, Ohman EM, Stevenson WG, Yancy CW (January 2013). "2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 127 (4): e362–425. doi:10.1161/CIR.0b013e3182742cf6. PMID 23247304.
5. Signs and symptoms ofhyperglycemiaandhypoglycemia, and measures to take when they occur. (See accompanying table.) It is important for patients to become familiar with specific signs that are unique to themselves. Each person responds differently and may exhibit symptoms different from those experienced by others. It should be noted that the signs and symptoms may vary even within one individual. Thus it is vital that the person understand all reactions that could occur. When there is doubt, a simple blood glucose reading will determine the actions that should be taken.
Often people don't experience symptoms of diabetes until their blood sugars are very high. Symptoms of diabetes include: increased thirst, increased urination, increased hunger, extreme fatigues, numbness and tingling in the extremities (hands and feet), cuts and wounds that are slow to heal, and blurred vision. Some people also experience other less common symptoms including weight loss, dry itchy skin, increased yeast infections, erectile dysfunction, and acanthosis nigricans (thick, "velvety" patches found in the folds or creases of skin, such as the neck, that is indicative of insulin resistance).
Jump up ^ Rubino, F; Nathan, DM; Eckel, RH; Schauer, PR; Alberti, KG; Zimmet, PZ; Del Prato, S; Ji, L; Sadikot, SM; Herman, WH; Amiel, SA; Kaplan, LM; Taroncher-Oldenburg, G; Cummings, DE; Delegates of the 2nd Diabetes Surgery, Summit (June 2016). "Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations". Diabetes Care. 39 (6): 861–77. doi:10.2337/dc16-0236. PMID 27222544.
Abnormal cholesterol and triglyceride levels. If you have low levels of high-density lipoprotein (HDL), or "good," cholesterol, your risk of type 2 diabetes is higher. Triglycerides are another type of fat carried in the blood. People with high levels of triglycerides have an increased risk of type 2 diabetes. Your doctor can let you know what your cholesterol and triglyceride levels are.