Because type 2 diabetes is linked to high levels of sugar in the blood, it may seem logical to assume that eating too much sugar is the cause of the disease. But of course, it’s not that simple. “This has been around for years, this idea that eating too much sugar causes diabetes — but the truth is, type 2 diabetes is a multifactorial disease with many different types of causes,” says Lynn Grieger, RDN, CDE, a nutrition coach in Prescott, Arizona, and a medical reviewer for Everyday Health. “Type 2 diabetes is really complex.”
Clear evidence suggests a genetic component in type 1 diabetes mellitus. Monozygotic twins have a 60% lifetime concordance for developing type 1 diabetes mellitus, although only 30% do so within 10 years after the first twin is diagnosed. In contrast, dizygotic twins have only an 8% risk of concordance, which is similar to the risk among other siblings.
There is strong evidence that the long-term complications are related to the degree and duration of metabolic disturbances.2 These considerations form the basis of standard and innovative therapeutic approaches to this disease that include newer pharmacologic formulations of insulin, delivery by traditional and more physiologic means, and evolving methods to continuously monitor blood glucose to maintain it within desired limits by linking these features to algorithm-driven insulin delivery pumps for an “artificial pancreas.”
Diabetes mellitus is a chronic disease for which there is treatment but no known cure.  Treatment is aimed at keeping blood glucose levels as close to normal as possible.  This is achieved with a combination of diet, exercise and insulin or oral medication.  People with type 1 diabetes need to be hospitalized right after they are diagnosed to get their glucose levels down to an acceptable level.
Diet. In general, the diabetic diet is geared toward providing adequate nutrition with sufficient calories to maintain normal body weight; the intake of food is adjusted so that blood sugar and serum cholesterol levels are kept within acceptable limits. Overweight diabetic patients should limit caloric intake until target weight is achieved. In persons with type 2 diabetes this usually results in marked improvement and may eliminate the need for drugs such as oral hypoglycemic agents.
To understand why insulin is important, it helps to know more about how the body uses food for energy. Your body is made up of millions of cells. To make energy, these cells need food in a very simple form. When you eat or drink, much of the food is broken down into a simple sugar called "glucose." Then, glucose is transported through the bloodstream to these cells where it can be used to provide the energy the body needs for daily activities.

The development of type 2 diabetes is caused by a combination of lifestyle and genetic factors.[24][26] While some of these factors are under personal control, such as diet and obesity, other factors are not, such as increasing age, female gender, and genetics.[10] A lack of sleep has been linked to type 2 diabetes.[27] This is believed to act through its effect on metabolism.[27] The nutritional status of a mother during fetal development may also play a role, with one proposed mechanism being that of DNA methylation.[28] The intestinal bacteria Prevotella copri and Bacteroides vulgatus have been connected with type 2 diabetes.[29]


Home blood glucose self-monitoring is indispensable in helping patients to adjust daily insulin doses according to test results and to achieve optimal long-term control of diabetes. Insulin or other hypoglycemic agents are administered as prescribed, and their action and use explained to the patient. With help from a dietitian, a diet is planned based on the recommended amount of calories, protein, carbohydrates, and fats. The amount of carbohydrates consumed is a dietary key to managing glycemic control in diabetes. For most men, 60 to 75 carbohydrate g per meal are a reasonable intake; for most women, 45 to 60 g are appropriate. Saturated fats should be limited to less than 7% of total caloric intake, and trans-fatty acids (unsaturated fats with hydrogen added) minimized. A steady, consistent level of daily exercise is prescribed, and participation in a supervised exercise program is recommended.
People with diabetes can benefit from education about the disease and treatment, good nutrition to achieve a normal body weight, and exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure.[80][81]
Insulin Therapy. Exogenous insulin is given to patients with diabetes mellitus as a supplement to the insufficient amount of endogenous insulin that they produce. In some cases, this must make up for an absolute lack of insulin from the pancreas. Exogenous insulin is available in various types. It must be given by injection, usually subcutaneously, and because it is a potent drug, the dosage must be measured meticulously. Commonly, regular insulin, which is a fast-acting insulin with a short span of action, is mixed with one of the longer-acting insulins and both types are administered in one injection.
Diabetes was one of the first diseases described,[107] with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine".[108] The Ebers papyrus includes a recommendation for a drink to be taken in such cases.[109] The first described cases are believed to be of type 1 diabetes.[108] Indian physicians around the same time identified the disease and classified it as madhumeha or "honey urine", noting the urine would attract ants.[108][109]

Because people with type 2 diabetes produce some insulin, ketoacidosis does not usually develop even when type 2 diabetes is untreated for a long time. Rarely, the blood glucose levels become extremely high (even exceeding 1,000 mg/dL). Such high levels often happen as the result of some superimposed stress, such as an infection or drug use. When the blood glucose levels get very high, people may develop severe dehydration, which may lead to mental confusion, drowsiness, and seizures, a condition called hyperosmolar hyperglycemic state. Currently, many people with type 2 diabetes are diagnosed by routine blood glucose testing before they develop such severely high blood glucose levels.
Diabetes was one of the first diseases described,[107] with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine".[108] The Ebers papyrus includes a recommendation for a drink to be taken in such cases.[109] The first described cases are believed to be of type 1 diabetes.[108] Indian physicians around the same time identified the disease and classified it as madhumeha or "honey urine", noting the urine would attract ants.[108][109]
Which came first: the diabetes or the PCOS? For many women, a diagnosis of polycystic ovary syndrome means a diabetes diagnosis isn’t far behind. PCOS and diabetes are both associated with insulin resistance, meaning there are similar hormonal issues at play in both diseases. Fortunately, managing your PCOS and losing weight may help reduce your risk of becoming diabetic over time.
Medications used to treat diabetes do so by lowering blood sugar levels. There is broad consensus that when people with diabetes maintain tight glucose control (also called "tight glycemic control") -- keeping the glucose levels in their blood within normal ranges - that they experience fewer complications like kidney problems and eye problems.[84][85] There is however debate as to whether this is cost effective for people later in life.[86]
If eaten as part of a healthy meal plan, or combined with exercise, sweets and desserts can be eaten by people with diabetes. They are no more "off limits" to people with diabetes than they are to people without diabetes. The key to sweets is to have a very small portion and save them for special occasions so you focus your meal on more healthful foods.
Know Your Numbers: Knowing your ABCs—A1c, blood pressure, and cholesterol—are important in reducing your risk for diabetes and keeping your diabetes in good control. If you are someone with diabetes who has elevated blood pressure or cholesterol, you are increasing your risk of heart attack and stroke. Your physician will give you your A1c, blood pressure, and cholesterol targets. Make sure you pay attention to them and understand what they mean and why they are important.
Insulin is vital to patients with type 1 diabetes - they cannot live without a source of exogenous insulin. Without insulin, patients with type 1 diabetes develop severely elevated blood sugar levels. This leads to increased urine glucose, which in turn leads to excessive loss of fluid and electrolytes in the urine. Lack of insulin also causes the inability to store fat and protein along with breakdown of existing fat and protein stores. This dysregulation, results in the process of ketosis and the release of ketones into the blood. Ketones turn the blood acidic, a condition called diabetic ketoacidosis (DKA). Symptoms of diabetic ketoacidosis include nausea, vomiting, and abdominal pain. Without prompt medical treatment, patients with diabetic ketoacidosis can rapidly go into shock, coma, and even death may result.

On behalf of the millions of Americans who live with or are at risk for diabetes, we are committed to helping you understand this chronic disease. Help us set the record straight and educate the world about diabetes and its risk factors by sharing the common questions and answers below. If you're new to type 2 diabetes, join our Living With Type 2 Diabetes program to get more facts.
Of course, you’re exhausted every now and then. But ongoing fatigue is an important symptom to pay attention to; it might mean the food you’re eating for energy isn’t being broken down and used by cells as it’s supposed to. “You’re not getting the fuel your body needs,” says Dobbins. “You’re going to be tired and feel sluggish.” But in many cases of type 2 diabetes, your sugar levels can be elevated for awhile, so these diabetes symptoms could come on slowly.
Threshold for diagnosis of diabetes is based on the relationship between results of glucose tolerance tests, fasting glucose or HbA1c and complications such as retinal problems.[10] A fasting or random blood sugar is preferred over the glucose tolerance test, as they are more convenient for people.[10] HbA1c has the advantages that fasting is not required and results are more stable but has the disadvantage that the test is more costly than measurement of blood glucose.[50] It is estimated that 20% of people with diabetes in the United States do not realize that they have the disease.[10]

Jump up ^ Boussageon, R; Bejan-Angoulvant, T; Saadatian-Elahi, M; Lafont, S; Bergeonneau, C; Kassaï, B; Erpeldinger, S; Wright, JM; Gueyffier, F; Cornu, C (2011-07-26). "Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials". The BMJ. 343: d4169. doi:10.1136/bmj.d4169. PMC 3144314. PMID 21791495.
While there are competing explanations of the link between obesity and type 2 diabetes, Gerald Shulman, MD, PhD, a professor of internal medicine and physiology at Yale University, believes the key is figuring out insulin resistance. He has studied the causes of insulin resistance for 25 years and thinks he may have the answer to the weight-diabetes link.
Type 1 DM is caused by autoimmune destruction of the insulin-secreting beta cells of the pancreas. The loss of these cells results in nearly complete insulin deficiency; without exogenous insulin, type 1 DM is rapidly fatal. Type 2 DM results partly from a decreased sensitivity of muscle cells to insulin-mediated glucose uptake and partly from a relative decrease in pancreatic insulin secretion.

Because both yeast and bacteria multiply more quickly when blood sugar levels are elevated, women with diabetes are overall at a higher risk of feminine health issues, such as bacterial infections, yeast infections, and vaginal thrush, especially when blood sugar isn't well controlled. And a lack of awareness about having prediabetes or diabetes can make managing blood sugar impossible.
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