Endocrinology A chronic condition which affects ±10% of the general population, characterized by ↑ serum glucose and a relative or absolute ↓ in pancreatic insulin production, or ↓ tissue responsiveness to insulin; if not properly controlled, the excess glucose damages blood vessels of the eyes, kidneys, nerves, heart Types Insulin dependent–type I and non-insulin dependent–type II diabetes Symptoms type 1 DM is associated with ↑ urine output, thirst, fatigue, and weight loss (despite an ↑ appetite), N&V; type 2 DM is associated with, in addition, non-healing ulcers, oral and bladder infections, blurred vision, paresthesias in the hands and feet, and itching Cardiovascular MI, stoke Eyes Retinal damage, blindness Legs/feet Nonhealing ulcers, cuts leading to gangrene and amputation Kidneys HTN, renal failure Neurology Paresthesias, neuropathy Diagnosis Serum glucose above cut-off points after meals or when fasting; once therapy is begun, serum levels of glycosylated Hb are measured periodically to assess adequacy of glucose control Management Therapy reflects type of DM; metformin and triglitazone have equal and additive effects on glycemic control Prognosis A function of stringency of glucose control and presence of complications. See ABCD Trial, Brittle diabetes, Bronze diabetes, Chemical diabetes, Gestational diabetes, Insulin-dependent diabetes, Metformin, MODY diabetes, Nephrogenic diabetes insipidus, Non-insulin-dependent diabetes mellitus, Pseudodiabetes, Secondary diabetes, Starvation diabetes, Troglitazone.
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.
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.
The above tips are important for you. But it's also crucial to allow yourself time to cope with the diagnosis and commit to making lifestyle changes that will benefit you forever. The good news is the diabetes is a manageable disease; the tough part is that you must think about it daily. Consider finding support—someone that you can talk to about your struggles—be that a friend, another person with diabetes, or a loved one. This may seem trivial, but it truly can help you take control of diabetes so that it doesn't control you. Some next steps that may help you to get on the right track at this early stage in your journey:
Some people who have type 2 diabetes can achieve their target blood sugar levels with diet and exercise alone, but many also need diabetes medications or insulin therapy. The decision about which medications are best depends on many factors, including your blood sugar level and any other health problems you have. Your doctor might even combine drugs from different classes to help you control your blood sugar in several different ways.
In countries using a general practitioner system, such as the United Kingdom, care may take place mainly outside hospitals, with hospital-based specialist care used only in case of complications, difficult blood sugar control, or research projects. In other circumstances, general practitioners and specialists share care in a team approach. Home telehealth support can be an effective management technique.[100]

 Type 1 diabetes mellitus is a chronic metabolic syndrome defined by an inability to produce insulin, a hormone which lowers blood sugar. This leads to inappropriate hyperglycaemia (increased blood sugar levels) and deranged metabolism of carbohydrates, fats and proteins. Insulin is normally produced in the pancreas, a glandular organ involved in the production of digestive enzymes and hormones such as insulin and glucagon. These functions are carried out in the exocrine and endocrine (Islets of Langerhans) pancreas respectively.
In people with type 1 diabetes, the symptoms often begin abruptly and dramatically. A serious condition called diabetic ketoacidosis, a complication in which the body produces excess acid, may quickly develop. In addition to the usual diabetes symptoms of excessive thirst and urination, the initial symptoms of diabetic ketoacidosis also include nausea, vomiting, fatigue, and—particularly in children—abdominal pain. Breathing tends to become deep and rapid as the body attempts to correct the blood’s acidity (see Acidosis), and the breath smells fruity and like nail polish remover. Without treatment, diabetic ketoacidosis can progress to coma and death, sometimes very quickly.

Getting diagnosed with diabetes can be shocking, but the good news is that, although it is a disease you must deal with daily, it is a manageable one. If you are experiencing any of the above symptoms, especially if you are someone who is at high risk, you should meet with your primary care physician to get tested. The earlier a diagnosis is made, the more likely you can get your diabetes under control and prevent complications.
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.
History of diabetes: Past treatments and new discoveries Diabetes has been known for at least 2,000 years. Over the years, treatments have included exercise, riding on horseback, drinking wine, consuming milk or rice, opium, and overfeeding. It was not until 1921 that insulin was introduced as a treatment. Science has progressed, but diabetes remains a major health problem. Read now

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.
How does type 2 diabetes progress over time? Type 2 diabetes is a progressive disease, meaning that the body’s ability to regulate blood sugar gets worse over time, despite careful management. Over time, the body’s cells become increasingly less responsive to insulin (increased insulin resistance) and beta cells in the pancreas produce less and less insulin (called beta-cell burnout). In fact, when people are diagnosed with type 2 diabetes, they usually have already lost up to 50% or more of their beta cell function. As type 2 diabetes progresses, people typically need to add one or more different types of medications. The good news is that there are many more choices available for treatments, and a number of these medications don’t cause as much hypoglycemia, hunger and/or weight gain (e.g., metformin, pioglitazone, DPP-4 inhibitors, GLP-1 agonists, SGLT-2 inhibitors, and better insulin). Diligent management early on can help preserve remaining beta cell function and sometimes slow progression of the disease, although the need to use more and different types of medications does not mean that you have failed.
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If you recognize any of the symptoms, contact your doctor immediately. A simple in-office test for sugar in the urine is used for diagnosis. If that test is positive, then a drop of blood from the fingertip will confirm diabetes. Every day, thousands of adults and children around the world are diagnosed, but many go undetected. Early diagnosis cannot prevent Type 1, but it can head off potentially devastating, even fatal, health concerns.
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.
It's not as clear what the rest of the type 1 genes are up to, but researchers are eager to find out. "Even though something accounts for a small part [of the genetic risk], it could have a significant impact," says Stephen Rich, PhD, director of the Center for Public Health Genomics at the University of Virginia School of Medicine. Understanding these genes' role may clue researchers in to less obvious biological pathways involved in type 1 diabetes, and to possible prevention strategies.
Many older people have difficulty following a healthy, balanced diet that can control blood glucose levels and weight. Changing long-held food preferences and dietary habits may be hard. Some older people have other disorders that can be affected by diet and may not understand how to integrate the dietary recommendations for their various disorders.
In ‘type 2 diabetes’ (previously called non-insulin-dependent diabetes mellitus), which accounts for 90% of all diabetes, the beta cells do not stop making insulin completely, but the insulin produced does not work properly so it struggles to store the sugar found in the blood. As a consequence, the pancreas has to produce more insulin to compensate for this reduction in insulin function. This is called insulin resistance and is commonly linked to obesity. This type of diabetes is seen more commonly over the age of 40 years but can occur at any age.  
Can diabetes be prevented? Why are so many people suffering from it now over decades past? While there will never be anyway to possibly avoid genetic diabetes, there have been cases where dietary changes could perhaps have been made to delay or prevent the ailment from further developing. Doctors report that obesity plays a role, as well as activity levels, and even overall mental health often can be common threads of pre-diabetic patients.
Diabetic foot disease, due to changes in blood vessels and nerves, often leads to ulceration and subsequent limb amputation. It is one of the most costly complications of diabetes, especially in communities with inadequate footwear. It results from both vascular and neurological disease processes. Diabetes is the most common cause of non-traumatic amputation of the lower limb, which may be prevented by regular inspection and good care of the foot.

There are many complications of diabetes. Knowing and understanding the signs of these complications is important. If caught early, some of these complications can be treated and prevented from getting worse. The best way to prevent complications of diabetes is to keep your blood sugars in good control. High glucose levels produce changes in the blood vessels themselves, as well as in blood cells (primarily erythrocytes) that impair blood flow to various organs.
Taking the drugs used to treat diabetes, particularly insulin, may be difficult for some older people. For those with vision problems or other problems that make accurately filling a syringe difficult, a caregiver can prepare the syringes ahead of time and store them in the refrigerator. People whose insulin dose is stable may purchase pre-filled syringes. Prefilled insulin pen devices may be easier for people with physical limitations. Some of these devices have large numbers and easy-to-turn dials.
Viral infections may be the most important environmental factor in the development of type 1 diabetes mellitus, [26] probably by initiating or modifying an autoimmune process. Instances have been reported of a direct toxic effect of infection in congenital rubella. One survey suggests enteroviral infection during pregnancy carries an increased risk of type 1 diabetes mellitus in the offspring. Paradoxically, type 1 diabetes mellitus incidence is higher in areas where the overall burden of infectious disease is lower.
Exposure to certain viral infections (mumps and Coxsackie viruses) or other environmental toxins may serve to trigger abnormal antibody responses that cause damage to the pancreas cells where insulin is made. Some of the antibodies seen in type 1 diabetes include anti-islet cell antibodies, anti-insulin antibodies and anti-glutamic decarboxylase antibodies. These antibodies can be detected in the majority of patients, and may help determine which individuals are at risk for developing type 1 diabetes.
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. [44]
You are more likely to develop type 2 diabetes if you are not physically active and are overweight or obese. Extra weight sometimes causes insulin resistance and is common in people with type 2 diabetes. The location of body fat also makes a difference. Extra belly fat is linked to insulin resistance, type 2 diabetes, and heart and blood vessel disease. To see if your weight puts you at risk for type 2 diabetes, check out these Body Mass Index (BMI) charts.

Type 2 diabetes typically starts with insulin resistance. That is, the cells of the body resist insulin’s efforts to escort glucose into the cells. What causes insulin resistance? It appears to be caused by an accumulation of microscopic fat particles within muscle and liver cells.4 This fat comes mainly from the diet—chicken fat, beef fat, cheese fat, fish fat, and even vegetable fat. To try to overcome insulin resistance, the pancreas produces extra insulin. When the pancreas can no longer keep up, blood sugar rises. The combination of insulin resistance and pancreatic cell failure leads to type 2 diabetes.
Type 2 diabetes is most common is those who are genetically predisposed and who are overweight, lead a sedentary lifestyle, have high blood pressure, and/or have insulin resistance due to excess weight. People of certain ethnicities are more likely to develop diabetes, too. These include: African Americans, Mexican Americans, American Indians, Native Hawaiians, Pacific Islanders, and Asian Americans. These populations are more likely to be overweight and have high blood pressure, which increases the risk of developing diabetes.

A study by Chan et al indicated that in pediatric patients with type 1 diabetes, the presence of hypoglycemia is a sign of decreased insulin sensitivity, while hyperglycemia in these patients, especially overnight, signals improved sensitivity to insulin. In contrast, the investigators found evidence that in pediatric patients with type 2 diabetes, markers of metabolic syndrome and hyperglycemia are associated with reduced insulin sensitivity. Patients in the study were between ages 12 and 19 years. [23]

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Another area of pathologic changes associated with diabetes mellitus is the nervous system (diabetic neuropathy), particularly in the peripheral nerves of the lower extremities. The patient typically experiences a “stocking-type” anesthesia beginning about 10 years after the onset of the disease. There may eventually be almost total anesthesia of the affected part with the potential for serious injury to the part without the patient being aware of it. In contrast, some patients experience debilitating pain and hyperesthesia, with loss of deep tendon reflexes.
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