Type 1 diabetes is considered an autoimmune disease. With an autoimmune disease, your immune system – which helps protect your body from getting sick – is engaged in too little or too much activity. In Type 1 diabetes, beta cells, which are a kind of cell in the pancreas that produces insulin, are destroyed. Our bodies use insulin to take the sugar from carbohydrates we eat and create fuel. With Type 1 diabetes, your body does not produce insulin, and that's why you need to use insulin as part of your treatment.
Blood glucose levels: persistently elevated blood sugar levels are diagnostic of diabetes mellitus. A specific test called a glucose tolerance test (GTT) may be performed. For this you need to be fasted and will be given a sugary drink. Your glucose level will then be measured at one and two hours after the doseto determine how welll your body copes with glucose.
The most common test used to diagnose diabetes is the fasting blood glucose. This test measures the glucose levels at a specific moment in time (normal is 80-110 mg/dl). In managing diabetes, the goal is to normalize blood glucose levels. It is generally accepted that by maintaining normalized blood glucose levels, one may delay or even prevent some of the complications associated with diabetes. Measures to manage diabetes include behavioral modification (proper diet, exercise) and drug therapies (oral hypoglycemics, insulin replacement). The choice of therapy prescribed takes into consideration the type and severity of the disease present and patient compliance. The physician may request the patient keep a log of their daily blood glucose measurements, in an effort to better assess therapeutic success. Another commonly obtained test is the hemoglobin A1c (HbA1c), which is a surrogate marker used to assess blood glucose levels over an extended period (2-3 months). This test provides the physician with a good picture of the patient’s glucose levels over time.
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.
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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.
Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood.
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Is it your fault for getting type 2 diabetes? No – type 2 diabetes is not a personal failing. It develops through a combination of factors that are still being uncovered and better understood. Lifestyle (food, exercise, stress, sleep) certainly plays a major role, but genetics play a significant role as well. Type 2 diabetes is often described in the media as a result of being overweight, but the relationship is not that simple. Many overweight individuals never get type 2, and some people with type 2 were never overweight, (although obesity is probably an underlying cause of insulin resistance). To make matters worse, when someone gains weight (for whatever reason), the body makes it extremely difficult to lose the new weight and keep it off. If it were just a matter of choice or a bit of willpower, we would probably all be skinny. At its core, type 2 involves two physiological issues: resistance to the insulin made by the person’s beta cells and too little insulin production relative to the amount one needs.
Eating a balanced diet that is rich in fiber, non-starchy vegetables, lean protein, and healthy fat can help get you to your goal weight and reduce your waist size and body mass index (BMI). Reducing your intake of sweetened beverages (juices, sodas) is the easiest way to lose weight and reduce blood sugars. If you are someone who has high blood pressure and are salt sensitive, aim to reduce your intake of sodium; do not add salt to your food, read package labels for added sodium, and reduce your intake of fast food and take out. Don't go on a diet. Instead, adapt a healthier way of eating, one that you'll enjoy for a long time.
Commonly, diabetic patients’ random blood glucose measurement will be greater than 200 mg/dL. Additionally, diabetic patients’ urinalysis will be positive for greater than 30 mg/g of microalbumin on at least two of three consecutive sampling dates. Type 2 diabetics who have had diabetes mellitus for more than 2 years will usually have a fasting C-peptide level greater than 1.0 ng/dL. Patients with type 1 diabetes will have islet cell and anti-insulin autoantibodies present in their blood within 6 months of diagnosis. These antibodies, though, usually fade after 6 months.
The classic symptoms of diabetes such as polyuria, polydypsia and polyphagia occur commonly in type 1 diabetes, which has a rapid development of severe hyperglycaemia and also in type 2 diabetes with very high levels of hyperglycaemia. Severe weight loss is common only in type 1 diabetes or if type 2 diabetes remains undetected for a long period. Unexplained weight loss, fatigue and restlessness and body pain are also common signs of undetected diabetes. Symptoms that are mild or have gradual development could also remain unnoticed.
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.
A metabolic disease in which carbohydrate use is reduced and that of lipid and protein enhanced; it is caused by an absolute or relative deficiency of insulin and is characterized, in more severe cases, by chronic hyperglycemia, glycosuria, water and electrolyte loss, ketoacidosis, and coma; long-term complications include neuropathy, retinopathy, nephropathy, generalized degenerative changes in large and small blood vessels, and increased susceptibility to infection.
a chronic metabolic disorder in which the use of carbohydrate is impaired and that of lipid and protein is enhanced. It is caused by an absolute or relative deficiency of insulin and is characterized, in more severe cases, by chronic hyperglycemia, glycosuria, water and electrolyte loss, ketoacidosis, and coma. Long-term complications include neuropathy, retinopathy, nephropathy, generalized degenerative changes in large and small blood vessels, and increased susceptibility to infection.
Over recent decades, and particularly in the past five years, researchers have found dozens of genes with links to diabetes. The count stands at about 50 genes for type 1 and 38 for type 2. The numbers have risen quickly in recent years because of advances in the gene-sequencing technology used to conduct genome-wide association studies. This technique involves taking the genetic compositions of a group of people with a disease and comparing them en masse to the genomes of people who don't have the disease.
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.
The body will attempt to dilute the high level of glucose in the blood, a condition called hyperglycemia, by drawing water out of the cells and into the bloodstream in an effort to dilute the sugar and excrete it in the urine. It is not unusual for people with undiagnosed diabetes to be constantly thirsty, drink large quantities of water, and urinate frequently as their bodies try to get rid of the extra glucose. This creates high levels of glucose in the urine.
For Candace Clark, bariatric surgery meant the difference between struggling with weight issues, including medical problems triggered by obesity, and enjoying renewed health and energy. "I felt like I was slowly dying," says Candace Clark, a 54-year-old Barron, Wisconsin, resident who had dealt with weight issues for years. "I was tired of feeling the way [...]
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.
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.
The most common complication of treating high blood glucose levels is low blood glucose levels (hypoglycemia). The risk is greatest for older people who are frail, who are sick enough to require frequent hospital admissions, or who are taking several drugs. Of all available drugs to treat diabetes, long-acting sulfonylurea drugs are most likely to cause low blood glucose levels in older people. When they take these drugs, they are also more likely to have serious symptoms, such as fainting and falling, and to have difficulty thinking or using parts of the body due to low blood glucose levels.
If, on the other hand, you are already starting to develop complications or your medication regimen has changed because your blood sugars are getting higher, remember that diabetes is a progressive disease—and sometimes these things just happen without any influence from your own actions. As you age, beta cells in the pancreas get tired and stop working. If you've had diabetes for 20 years and now need to start insulin, for example, it doesn't mean you've failed. It just means that your body needs some help. Make sure you continue to receive education and that you continue to have someone to lean on when you need it, and keep the lines of communication open with your doctor. It truly can make a difference.
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.