There are two main kinds of diabetes: type 1 diabetes and type 2 diabetes. More than 90% of all people with diabetes have type 2. Overall, more than 3 million Canadians have diabetes, and the number is rapidly rising. Over a third of people with type 2 diabetes are unaware they have the disease and are not receiving the required treatment because, for many people, early symptoms are not noticeable without testing.
Pre-clinical diabetes refers to the time during which destruction of pancreatic insulin-producing cells is occurring, but symptoms have not yet developed. This period may last for months to years. Normally, 80-90% of the pancreatic beta cells must be destroyed before any symptoms of diabetes develops. During this time, blood tests can identify some immunological markers of pancreatic cell destruction. However, there is currently no known treatment to prevent progression of pre-clinical diabetes to true diabetes mellitus.
What does the research say about proactive type 2 diabetes management? Research shows that proactive management can pay off in fewer complications down the road. In the landmark UKPDS study, 5,102 patients newly diagnosed with type 2 diabetes were followed for an average of 10 years to determine whether intensive use of blood glucose-lowering drugs would result in health benefits. Tighter average glucose control (an A1c of 7.0% vs. an A1c of 7.9%) reduced the rate of complications in the eyes, kidneys, and nervous system, by 25%. For every percentage point decrease in A1c (e.g., from 9% to 8%), there was a 25% reduction in diabetes-related deaths, and an 18% reduction in combined fatal and nonfatal heart attacks.
What are the symptoms of diabetes in women? Diabetes can have different effects on men and women. Learn all about the symptoms of diabetes experienced by women with this article, including how the disease may affect pregnancy and the menopause. This MNT Knowledge Center article will also look at gestational diabetes and the risk factors involved. Read now
Type 2 diabetes is partly preventable by staying a normal weight, exercising regularly, and eating properly.[1] Treatment involves exercise and dietary changes.[1] If blood sugar levels are not adequately lowered, the medication metformin is typically recommended.[7][14] Many people may eventually also require insulin injections.[9] In those on insulin, routinely checking blood sugar levels is advised; however, this may not be needed in those taking pills.[15] Bariatric surgery often improves diabetes in those who are obese.[8][16]
As with many conditions, treatment of type 2 diabetes begins with lifestyle changes, particularly in your diet and exercise. If you have type 2 diabetes, speak to your doctor and diabetes educator about an appropriate diet. You may be referred to a dietitian. It is also a good idea to speak with your doctor before beginning an exercise program that is more vigourous than walking to determine how much and what kind of exercise is appropriate.
Poor vision, limited manual dexterity due to arthritis, tremor, or stroke, or other physical limitations may make monitoring blood glucose levels more difficult for older people. However, special monitors are available. Some have large numerical displays that are easier to read. Some provide audible instructions and results. Some monitors read blood glucose levels through the skin and do not require a blood sample. People can consult a diabetes educator to determine which meter is most appropriate.
Can you “exercise your way” out of this problem? Sometimes you can; however, the key is exercising properly. For younger patients, it is best to exercise briefly and intensely. Within the first 20 minutes of intense exercise, your body burns its sugar stores, which are hanging out in liver and muscle again. After that, you start burning fat. Although this sounds good; and to some extent it is, if you spend hours running or exercising excessively, you train your body to burn fat efficiently, which subsequently lead to also training your body to store fat efficiently.
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.
In addition to learning about diabetes itself, older people may have to learn how to fit management of diabetes in with their management of other disorders. Learning about how to avoid complications, such as dehydration, skin breakdown, and circulation problems, and to manage factors that can contribute to complications of diabetes, such as high blood pressure and high cholesterol levels, is especially important. Such problems become more common as people age, whether they have diabetes or not.
^ Jump up to: a b c Simpson, Terry C.; Weldon, Jo C.; Worthington, Helen V.; Needleman, Ian; Wild, Sarah H.; Moles, David R.; Stevenson, Brian; Furness, Susan; Iheozor-Ejiofor, Zipporah (2015-11-06). "Treatment of periodontal disease for glycaemic control in people with diabetes mellitus". Cochrane Database of Systematic Reviews (11): CD004714. doi:10.1002/14651858.CD004714.pub3. ISSN 1469-493X. PMID 26545069.
In the sunshine, molecules in the skin are converted to vitamin D. But people stay indoors more these days, which could lead to vitamin D deficiency. Research shows that if mice are deprived of vitamin D, they are more likely to become diabetic. In people, observational studies have also found a correlation between D deficiency and type 1. "If you don't have enough D, then [your immune system] doesn't function like it should," says Chantal Mathieu, MD, PhD, a professor of experimental medicine and endocrinology at Katholieke Universiteit Leuven in Belgium. "Vitamin D is not the cause of type 1 diabetes. [But] if you already have a risk, you don't want to have vitamin D deficiency on board because that's going to be one of the little pushes that pushes you in the wrong direction."

If you are symptomatic (e.g., increased thirst or urination, unexplained weight loss), your doctor may only use a single test to diagnose diabetes/prediabetes. If you don't have any symptoms, one high blood glucose test doesn't necessarily mean you have diabetes/prediabetes. Your doctor will repeat one of the blood tests again on another day (generally 1 week later) to confirm the diagnosis.
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]
Type 2 DM is characterized by insulin resistance, which may be combined with relatively reduced insulin secretion.[11] The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor. However, the specific defects are not known. Diabetes mellitus cases due to a known defect are classified separately. Type 2 DM is the most common type of diabetes mellitus.[2]
Your doctor will check your blood glucose levels, and if you are diagnosed with diabetes, your doctor will guide you on a plan to keep your blood sugar levels normal. If your diabetes is mild, your doctor will likely recommend a diet plan, exercise, and weight loss. Your doctor may prescribe medications that help reduce blood sugar levels. In some women, insulin may be necessary.
People with glucose levels between normal and diabetic have impaired glucose tolerance (IGT) or insulin resistance. People with impaired glucose tolerance do not have diabetes, but are at high risk for progressing to diabetes. Each year, 1% to 5% of people whose test results show impaired glucose tolerance actually eventually develop diabetes. Weight loss and exercise may help people with impaired glucose tolerance return their glucose levels to normal. In addition, some physicians advocate the use of medications, such as metformin (Glucophage), to help prevent/delay the onset of overt diabetes.
Jump up ^ Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, Ingelsson E, Lawlor DA, Selvin E, Stampfer M, Stehouwer CD, Lewington S, Pennells L, Thompson A, Sattar N, White IR, Ray KK, Danesh J (June 2010). "Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies". Lancet. 375 (9733): 2215–22. doi:10.1016/S0140-6736(10)60484-9. PMC 2904878. PMID 20609967.
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.
The body’s immune system is responsible for fighting off foreign invaders, like harmful viruses and bacteria. In people with type 1 diabetes, the immune system mistakes the body’s own healthy cells for foreign invaders. The immune system attacks and destroys the insulin-producing beta cells in the pancreas. After these beta cells are destroyed, the body is unable to produce insulin.
Type 2 DM is characterized by insulin resistance, which may be combined with relatively reduced insulin secretion.[11] The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor. However, the specific defects are not known. Diabetes mellitus cases due to a known defect are classified separately. Type 2 DM is the most common type of diabetes mellitus.[2]
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
A type 2 diabetes diet or a type 2 diabetic diet is important for blood sugar (glucose) control in people with diabetes to prevent complications of diabetes. There are a variety of type 2 diabetes diet eating plans such as the Mediterranean diet, Paleo diet, ADA Diabetes Diet, and vegetarian diets.Learn about low and high glycemic index foods, what foods to eat, and what foods to avoid if you have type 2 diabetes.
Jump up ^ Zheng, Sean L.; Roddick, Alistair J.; Aghar-Jaffar, Rochan; Shun-Shin, Matthew J.; Francis, Darrel; Oliver, Nick; Meeran, Karim (17 April 2018). "Association Between Use of Sodium-Glucose Cotransporter 2 Inhibitors, Glucagon-like Peptide 1 Agonists, and Dipeptidyl Peptidase 4 Inhibitors With All-Cause Mortality in Patients With Type 2 Diabetes". JAMA. 319 (15): 1580. doi:10.1001/jama.2018.3024.
Diabetes has often been referred to as a "silent disease" for two reasons: 1) Many people with Type 2 diabetes walk around with symptoms for many years, but are not diagnosed until they develop a complication of the disease, such as blindness, kidney disease, or heart disease; 2) There are no specific physical manifestations in individuals with diabetes.  Therefore, unless a person chooses to disclose their disease, it is possible that friends and even family members may be unaware of a person's diagnosis.
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.

The patient, physician, nurse, and dietician must carefully evaluate the patient's life style, nutritional needs, and ability to comply with the proposed dietary prescription. There are a variety of meal planning systems that can be used by the patient with diabetes; each has benefits and drawbacks that need to be evaluated in order to maximize compliance. Two of the most frequently used ones are the exchange system (see accompanying table) and the carbohydrate counting system.
The levels of glucose in the blood vary normally throughout the day. They rise after a meal and return to pre-meal levels within about 2 hours after eating. Once the levels of glucose in the blood return to premeal levels, insulin production decreases. The variation in blood glucose levels is usually within a narrow range, about 70 to 110 milligrams per deciliter (mg/dL) of blood in healthy people. If people eat a large amount of carbohydrates, the levels may increase more. People older than 65 years tend to have slightly higher levels, especially after eating.
Unexplained weight loss can happen for lots of reasons, and diabetes is one of them. Goundan explains that insulin helps your body move sugar from your blood to your cells, so when you have an insulin resistance, you don’t get enough energy into your cells despite all that sugar flowing through your body. “Because you’re unable to get enough energy from sugar, your body burns your own fat and muscle for energy," Kellis says. "Weight loss can be pretty significant, sometimes 10 to 20 pounds."
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