The classic symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), and weight loss. Other symptoms that are commonly present at diagnosis include a history of blurred vision, itchiness, peripheral neuropathy, recurrent vaginal infections, and fatigue. Many people, however, have no symptoms during the first few years and are diagnosed on routine testing. A small number of people with type 2 diabetes mellitus can develop a hyperosmolar hyperglycemic state (a condition of very high blood sugar associated with a decreased level of consciousness and low blood pressure).
Treatment of high blood pressure and high cholesterol levels, which can contribute to circulation problems, can help prevent some of the complications of diabetes as well. A low dose of aspirin taken daily is recommended in people with risk factors for heart disease. All people with diabetes who are between 40 and 75 years are given a statin (a drug to decrease cholesterol levels) regardless of cholesterol levels. Younger people with an elevated risk of heart disease should also take a statin .
One of the most common ways people with type 2 diabetes attempt to lower their blood sugar is by drastically reducing their intake of carbs. The ADA agrees that carbohydrate counting is essential if you have diabetes, but extreme diets like the ketogenic diet, which reduces carb intake to as little as 5 percent of your daily calories, can be risky for some people with diabetes. (36)
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.
Research continues on diabetes prevention and improved detection of those at risk for developing diabetes. While the onset of Type I diabetes is unpredictable, the risk of developing Type II diabetes can be reduced by maintaining ideal weight and exercising regularly. The physical and emotional stress of surgery, illness, pregnancy, and alcoholism can increase the risks of diabetes, so maintaining a healthy lifestyle is critical to preventing the onset of Type II diabetes and preventing further complications of the disease.
Diabetes mellitus is a diagnostic term for a group of disorders characterized by abnormal glucose homeostasis resulting in elevated blood sugar. There is variability in its manifestations, wherein some individuals have only asymptomatic glucose intolerance, while others present acutely with diabetic ketoacidosis, and still others develop chronic complications such as nephropathy, neuropathy, retinopathy, or accelerated atherosclerosis. It is among the most common of chronic disorders, affecting up to 5–10% of the adult population of the Western world. Its prevalence varies over the globe, with certain populations, including some American Indian tribes and the inhabitants of Micronesia and Polynesia, having extremely high rates of diabetes (1,2). The prevalence of diabetes is increasing dramatically and it has been estimated that the worldwide prevalence will increase by more than 50% between the years 2000 and 2030 (3).
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
Another dipstick test can determine the presence of protein or albumin in the urine. Protein in the urine can indicate problems with kidney function and can be used to track the development of renal failure. A more sensitive test for urine protein uses radioactively tagged chemicals to detect microalbuminuria, small amounts of protein in the urine, that may not show up on dipstick tests.
A second oral agent of another class or insulin may be added if metformin is not sufficient after three months. Other classes of medications include: sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, SGLT2 inhibitors, and glucagon-like peptide-1 analogs. As of 2015 there was no significant difference between these agents. A 2018 review found that SGLT2 inhibitors may be better than glucagon-like peptide-1 analogs or dipeptidyl peptidase-4 inhibitors.
Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization (WHO) when the current taxonomy was introduced in 1999.
Schedule a yearly physical exam and regular eye exams. Your regular diabetes checkups aren't meant to replace regular physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications, as well as screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma.
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).
The treatment of low blood sugar consists of administering a quickly absorbed glucose source. These include glucose containing drinks, such as orange juice, soft drinks (not sugar-free), or glucose tablets in doses of 15-20 grams at a time (for example, the equivalent of half a glass of juice). Even cake frosting applied inside the cheeks can work in a pinch if patient cooperation is difficult. If the individual becomes unconscious, glucagon can be given by intramuscular injection.
When you have diabetes, excess sugar (glucose) builds up in your blood. Your kidneys are forced to work overtime to filter and absorb the excess sugar. If your kidneys can't keep up, the excess sugar is excreted into your urine, dragging along fluids from your tissues. This triggers more frequent urination, which may leave you dehydrated. As you drink more fluids to quench your thirst, you'll urinate even more.
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.
Patients with type 1 DM, unless they have had a pancreatic transplant, require insulin to live; intensive therapy with insulin to limit hyperglycemia (“tight control”) is more effective than conventional therapy in preventing the progression of serious microvascular complications such as kidney and retinal diseases. Intensive therapy consists of three or more doses of insulin injected or administered by infusion pump daily, with frequent self-monitoring of blood glucose levels as well as frequent changes in therapy as a result of contacts with health care professionals. Some negative aspects of intensive therapy include a three times more frequent occurrence of severe hypoglycemia, weight gain, and an adverse effect on serum lipid levels, i.e., a rise in total cholesterol, LDL cholesterol, and triglycerides and a fall in HDL cholesterol. Participation in an intensive therapy program requires a motivated patient, but it can dramatically reduce eye, nerve, and renal complications compared to conventional therapy. See: insulin pump for illus.
High blood sugar levels (hyperglycemia) can lead to a condition called glucose toxicity. This leads to further damage to the pancreas, and the body is less able to produce insulin. Without insulin, glucose levels continue to rise to levels that can cause damage to organs such as the eyes, nerves, and kidneys. These problems are similar to the complications associated with type 1 diabetes.
Get to Know Your Medications: If you have diabetes, it is important to know and understand what your medications do. This can help to keep blood sugars controlled and prevent low and high blood sugars. Certain medicines need to be taken with food, or they will cause your blood sugar will drop. There are so many diabetes medications out there. Being your own advocate can help you. Make sure to tell your doctor if your medications are too expensive or if they are causing any side effects. If your medication regimen is not working for you, odds are your doctor can find a new medicine that might work better.
Jump up ^ Imperatore, Giuseppina; Boyle, James P.; Thompson, Theodore J.; Case, Doug; Dabelea, Dana; Hamman, Richard F.; Lawrence, Jean M.; Liese, Angela D.; Liu, Lenna L. (December 2012). "Projections of Type 1 and Type 2 Diabetes Burden in the U.S. Population Aged <20 Years Through 2050". Diabetes Care. 35 (12): 2515–20. doi:10.2337/dc12-0669. ISSN 0149-5992. PMC 3507562. PMID 23173134. Archived from the original on 2016-08-14.
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.
Diabetes can also be diagnosed if a blood glucose level taken any time of the day without regards to meals is 11.1 mmol/L or higher, plus you have symptoms characteristic of diabetes (e.g., increase thirst, increase urination, unexplained weight loss). A doctor may also examine the eyes for signs of damage to the blood vessels of the retina (back of the eye). Finally, diabetes mellitus is diagnosed if the 3-month cumulative blood sugar average test, known as hemoglobin A1C or glycated hemoglobin, is 6.5% or higher.
Polyuria is defined as an increase in the frequency of urination. When you have abnormally high levels of sugar in your blood, your kidneys draw in water from your tissues to dilute that sugar, so that your body can get rid of it through the urine. The cells are also pumping water into the bloodstream to help flush out sugar, and the kidneys are unable to reabsorb this fluid during filtering, which results in excess urination.
All children with type 1 diabetes mellitus require insulin therapy. Most require 2 or more injections of insulin daily, with doses adjusted on the basis of self-monitoring of blood glucose levels. Insulin replacement is accomplished by giving a basal insulin and a preprandial (premeal) insulin. The basal insulin is either long-acting (glargine or detemir) or intermediate-acting (NPH). The preprandial insulin is either rapid-acting (lispro, aspart, or glulisine) or short-acting (regular).
In general, women live longer than men do because they have a lower risk of heart disease, but when women develop diabetes, their risk for heart disease skyrockets, and death by heart failure is more likely in women than in men. Another study also found that in people with diabetes, heart attacks are more often fatal for women than they are for men. Other examples of how diabetes affects women differently than men are:
Diagnosis. The most common diagnostic tests for diabetes are chemical analyses of the blood such as the fasting plasma glucose. Capillary blood glucose monitoring can be used for screening large segments of the population. Portable equipment is available and only one drop of blood from the fingertip or earlobe is necessary. Capillary blood glucose levels have largely replaced analysis of the urine for glucose. Testing for urinary glucose can be problematic as the patient may have a high renal threshold, which would lead to a negative reading for urinary glucose when in fact the blood glucose level was high.
The diabetic patient should learn to recognize symptoms of low blood sugar (such as confusion, sweats, and palpitations) and high blood sugar (such as, polyuria and polydipsia). When either condition results in hospitalization, vital signs, weight, fluid intake, urine output, and caloric intake are accurately documented. Serum glucose and urine ketone levels are evaluated. Chronic management of DM is also based on periodic measurement of glycosylated hemoglobin levels (HbA1c). Elevated levels of HbA1c suggest poor long-term glucose control. The effects of diabetes on other body systems (such as cerebrovascular, coronary artery, and peripheral vascular) should be regularly assessed. Patients should be evaluated regularly for retinal disease and visual impairment and peripheral and autonomic nervous system abnormalities, e.g., loss of sensation in the feet. The patient is observed for signs and symptoms of diabetic neuropathy, e.g., numbness or pain in the hands and feet, decreased vibratory sense, footdrop, and neurogenic bladder. The urine is checked for microalbumin or overt protein losses, an early indication of nephropathy. The combination of peripheral neuropathy and peripheral arterial disease results in changes in the skin and microvasculature that lead to ulcer formation on the feet and lower legs with poor healing. Approx. 45,000 lower-extremity diabetic amputations are performed in the U.S. each year. Many amputees have a second amputation within five years. Most of these amputations are preventable with regular foot care and examinations. Diabetic patients and their providers should look for changes in sensation to touch and vibration, the integrity of pulses, capillary refill, and the skin. All injuries, cuts, and blisters should be treated promptly. The patient should avoid constricting hose, slippers, shoes, and bed linens or walking barefoot. The patient with ulcerated or insensitive feet is referred to a podiatrist for continuing foot care and is warned that decreased sensation can mask injuries.
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.
Exercise. A program of regular exercise gives anyone a sense of good health and well-being; for persons with diabetes it gives added benefits by helping to control blood glucose levels, promoting circulation to peripheral tissues, and strengthening the heart beat. In addition, there is evidence that exercise increases the number of insulin receptor sites on the surface of cells and thus facilitates the metabolism of glucose. Many specialists in diabetes consider exercise so important in the management of diabetes that they prescribe rather than suggest exercise.
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.
Reduce Your Carbohydrate Intake: One of the most important components involved in a diabetes diet is knowing how to eat a modified carbohydrate diet. Carbohydrates are the nutrient that impacts blood sugars the most. Carbohydrates are found in starches, fruit, some vegetables like potatoes, sweets, and grains. Eating the right kinds of carbohydrate in the right quantities can help you manage your weight and your blood sugars. Knowing how to identify and count carbohydrates is very important in managing diabetes. Eating a consistent carbohydrate diet is ideal because it can help you body regulate blood sugars.
Diabetes mellitus type 2 is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. This is in contrast to diabetes mellitus type 1 in which there is an absolute insulin deficiency due to destruction of islet cells in the pancreas and gestational diabetes mellitus that is a new onset of high blood sugars associated with pregnancy. Type 1 and type 2 diabetes can typically be distinguished based on the presenting circumstances. If the diagnosis is in doubt antibody testing may be useful to confirm type 1 diabetes and C-peptide levels may be useful to confirm type 2 diabetes, with C-peptide levels normal or high in type 2 diabetes, but low in type 1 diabetes.
Keeping track of the number of calories provided by different foods can become complicated, so patients usually are advised to consult a nutritionist or dietitian. An individualized, easy to manage diet plan can be set up for each patient. Both the American Diabetes Association and the American Dietetic Association recommend diets based on the use of food exchange lists. Each food exchange contains a known amount of calories in the form of protein, fat, or carbohydrate. A patient's diet plan will consist of a certain number of exchanges from each food category (meat or protein, fruits, breads and starches, vegetables, and fats) to be eaten at meal times and as snacks. Patients have flexibility in choosing which foods they eat as long as they stick with the number of exchanges prescribed.
Kidney disease: According to the Centers for Disease Control and Prevention (CDC), an estimated 33 percent of people with diabetes have chronic kidney disease. Diabetes can also damage blood vessels in the kidneys, impairing function. The kidneys play a vital role in balancing fluid levels and removing waste from the body. Kidney health is therefore vital for preserving overall health.
Type 2 diabetes is usually associated with being overweight (BMI greater than 25), and is harder to control when food choices are not adjusted, and you get no physical activity. And while it’s true that too much body fat and physical inactivity (being sedentary) does increase the likelihood of developing type 2, even people who are fit and trim can develop this type of diabetes.2,3
The World Health Organization recommends testing those groups at high risk and in 2014 the USPSTF is considering a similar recommendation. High-risk groups in the United States include: those over 45 years old; those with a first degree relative with diabetes; some ethnic groups, including Hispanics, African-Americans, and Native-Americans; a history of gestational diabetes; polycystic ovary syndrome; excess weight; and conditions associated with metabolic syndrome. The American Diabetes Association recommends screening those who have a BMI over 25 (in people of Asian descent screening is recommended for a BMI over 23).
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.
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).
There is an overall lack of public awareness of the signs and symptoms of type 1 diabetes. Making yourself aware of the signs and symptoms of type 1 diabetes is a great way to be proactive about your health and the health of your family members. If you notice any of these signs or symptoms, it’s possible that you have (or your child has) type 1 diabetes. A doctor can make that diagnosis by checking blood glucose levels.
Type 2 diabetes is due to insufficient insulin production from beta cells in the setting of insulin resistance. Insulin resistance, which is the inability of cells to respond adequately to normal levels of insulin, occurs primarily within the muscles, liver, and fat tissue. In the liver, insulin normally suppresses glucose release. However, in the setting of insulin resistance, the liver inappropriately releases glucose into the blood. The proportion of insulin resistance versus beta cell dysfunction differs among individuals, with some having primarily insulin resistance and only a minor defect in insulin secretion and others with slight insulin resistance and primarily a lack of insulin secretion.
Prediabetes is a condition in which blood glucose levels are too high to be considered normal but not high enough to be labeled diabetes. People have prediabetes if their fasting blood glucose level is between 100 mg/dL and 125 mg/dL or if their blood glucose level 2 hours after a glucose tolerance test is between 140 mg/dL and 199 mg/dL. Prediabetes carries a higher risk of future diabetes as well as heart disease. Decreasing body weight by 5 to 10% through diet and exercise can significantly reduce the risk of developing future diabetes.
While discovering you have diabetes can be a terrifying prospect, the sooner you’re treated, the more manageable your condition will be. In fact, a review of research published in the American Diabetes Association journal Diabetes Care reveals that early treatment with insulin can help patients with type 2 diabetes manage their blood sugar better and gain less weight than those who start treatment later.
Complications of diabetes are responsible for considerable morbidity and mortality. The acute complications of diabetes are hypo- and hyperglycemic coma and infections. The chronic complications include microvascular complications such as retinopathy and nephropathy, and the macrovascular complications of heart disease and stroke. Diabetes mellitus is the commonest cause of blindness and renal failure in the UK and the USA. Other common complications include autonomic and peripheral neuropathy. A combination of vascular and neuropathic disturbances results in a high prevalence of impotence in men with diabetes. Peripheral neuropathy causes lack of sensation in the feet which can cause minor injuries to go unnoticed, become infected and, with circulatory problems obstructing healing, ulceration and gangrene are serious risks and amputation is not uncommon. Evidence from meta-analysis of studies of the relationship between glycemic control and microvascular complications (Wang, Lau, & Chalmers, 1993), and from the longitudinal multicenter Diabetes Control and Complications Trial (DCCT) in the USA (DCCT Research Group, 1993), have established a clear relationship between improved blood glucose control and reduction of risk of retinopathy and other microvascular complications in insulin-dependent diabetes mellitus (IDDM). It is likely that there would be similar findings for noninsulin-dependent diabetes mellitus (NIDDM) though the studies did not include NIDDM patients. However, the DCCT included highly selected, well-motivated, well-educated and well-supported patients, cared for by well-staffed diabetes care teams involving educators and psychologists as well as diabetologists and diabetes specialist nurses.
There are a range of different symptoms in people with diabetes. They may feel thirsty, pass a large amount of urine, wake up overnight to pass urine, lose weight and have blurred vision. Patients are vulnerable to infections such as thrush and may present with this. Particularly in type 2 diabetes, patients may not be aware of their diabetes for several years and a diagnosis may only be made when they seek treatment for diabetes-related complications such as foot, eye or kidney problems. Some patients may become severely ill and be taken into hospital with an infection and/or very high blood sugar levels.
Diabetes mellitus (DM) comprises a group of disorders characterized by hyperglycemia. It is the sixth leading cause of death in the United States and results in $132 billion in total direct and indirect costs. Although the incidence of Type 1 diabetes has doubled over the past 30 years, the increase in Type 2 diabetes has been even more dramatic. An estimated 20–40% of cases in large pediatric diabetes centers are now Type 2, and the rates are expected to rise along with the epidemic of childhood and adolescent obesity (Chapter 11).
Type 1 diabetes occurs because the insulin-producing cells of the pancreas (beta cells) are damaged. In type 1 diabetes, the pancreas makes little or no insulin, so sugar cannot get into the body's cells for use as energy. People with type 1 diabetes must use insulin injections to control their blood glucose. Type 1 is the most common form of diabetes in people who are under age 30, but it can occur at any age. Ten percent of people with diabetes are diagnosed with type 1.
Is type 2 diabetes serious? Type 2 diabetes is not a death sentence, but it is a very serious disease that demands attention and careful monitoring. There is no such thing as ‘mild’ diabetes. Elevated glucose levels can damage the nervous system, blood vessels, eyes, heart, and kidneys. These complications really impact quality of life (through blindness, amputations, dialysis etc). They also significantly increase the chance of a stroke or heart attack. Managing blood glucose levels immediately, along with other health risk factors (e.g., cholesterol, blood pressure, weight), is necessary for preventing these complications. Losing even a small amount of weight and keeping it off can also improve glucose control as well as have other clinical benefits (read more tips on managing diet and exercise below for more on weight loss). Keep in mind that better diabetes management also has benefits in the here and now – mood and energy levels are adversely affected when your glucose levels are high.
Type 2 Diabetes: Accounting for 90 to 95 percent of those with diabetes, type 2 is the most common form. Usually, it's diagnosed in adults over age 40 and 80 percent of those with type 2 diabetes are overweight. Because of the increase in obesity, type 2 diabetes is being diagnosed at younger ages, including in children. Initially in type 2 diabetes, insulin is produced, but the insulin doesn't function properly, leading to a condition called insulin resistance. Eventually, most people with type 2 diabetes suffer from decreased insulin production.