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.
Talking to a counselor or therapist may help you cope with the lifestyle changes that come with a type 2 diabetes diagnosis. You may find encouragement and understanding in a type 2 diabetes support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences or helpful information, such as where to find carbohydrate counts for your favorite takeout restaurant. If you're interested, your doctor may be able to recommend a group in your area.
Unlike many health conditions, diabetes is managed mostly by you, with support from your health care team (including your primary care doctor, foot doctor, dentist, eye doctor, registered dietitian nutritionist, diabetes educator, and pharmacist), family, and other important people in your life. Managing diabetes can be challenging, but everything you do to improve your health is worth it!
Jump up ^ Seida, Jennifer C.; Mitri, Joanna; Colmers, Isabelle N.; Majumdar, Sumit R.; Davidson, Mayer B.; Edwards, Alun L.; Hanley, David A.; Pittas, Anastassios G.; Tjosvold, Lisa; Johnson, Jeffrey A. (Oct 2014). "Effect of Vitamin D3 Supplementation on Improving Glucose Homeostasis and Preventing Diabetes: A Systematic Review and Meta-Analysis". The Journal of Clinical Endocrinology & Metabolism. 99 (10): 3551–60. doi:10.1210/jc.2014-2136. PMC 4483466. PMID 25062463.
Type 1 diabetes is always treated with insulin, a life-saving treatment. Patients will need to take insulin several times a day for the rest of their lives. They will usually learn how to self-administer this. Insulin is usually given through injections under the skin, normally two to four times a day. An increasing number of patients with type 1 diabetes are being treated with ‘insulin pumps’, which provide a continuous supply of insulin. 
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.

Unlike people with type 1 diabetes, people with type 2 diabetes produce insulin; however, the insulin their pancreas secretes is either not enough or the body is unable to recognize the insulin and use it properly (insulin resistance). When there isn't enough insulin or the insulin is not used as it should be, glucose (sugar) can't get into the body's cells and builds up in the bloodstream instead. When glucose builds up in the blood instead of going into cells, it causes damage in multiple areas of the body. Also, since cells aren't getting the glucose they need, they can't function properly.


People with diabetes either don't make insulin or their body's cells no longer are able to use the insulin, leading to high blood sugars. By definition, diabetes is having a blood glucose level of greater than or equal to126 milligrams per deciliter (mg/dL) after an 8-hour fast (not eating anything), or by having a non-fasting glucose level greater than or equal to 200 mg/dL along with symptoms of diabetes, or a glucose level of greater than or equal to 200 mg/dL on a 2-hour glucose tolerance test, or an A1C greater than or equal to 6.5%. Unless the person is having obvious symptoms of diabetes or is in a diabetic crisis, the diagnosis must be confirmed with a repeat test.

Glucose in your body can cause yeast infections. This is because glucose speeds the growth of fungus. There are over-the-counter and prescription medications to treat yeast infections. You can potentially avoid yeast infections by maintaining better control of your blood sugar. Take insulin as prescribed, exercise regularly, reduce your carb intake, choose low-glycemic foods, and monitor your blood sugar.


When you have diabetes, your body becomes less efficient at breaking food down into sugar, so you have more sugar sitting in your bloodstream, says Dobbins. “Your body gets rid of it by flushing it out in the urine.” So going to the bathroom a lot could be one of the diabetes symptoms you’re missing. Most patients aren’t necessarily aware of how often they use the bathroom, says Dr. Cypess. “When we ask about it, we often hear, ‘Oh yeah, I guess I’m going more often than I used to,’” he says. But one red flag is whether the need to urinate keeps you up at night. Once or twice might be normal, but if it’s affecting your ability to sleep, that could be a diabetes symptom to pay attention to. Make sure you know these diabetes myths that could sabotage your health.
Don’t be alarmed: This is not diabetic retinopathy, where the blood vessels in the back of the eye are getting destroyed, says Dr. Cypess. In the early stages of diabetes, the eye lens is not focusing well because glucose builds up in the eye, which temporarily changes its shape. “You’re not going blind from diabetes,” Dr. Cypess says he assures patients. “In about six to eight weeks after your blood sugars are stabilized, you’re not going to feel it anymore; the eye will adjust.” Here are more surprising facts you never knew about diabetes.

Type 1 diabetes in pediatric patients has been linked to changes in cognition and brain structure, with a study by Siller et al finding lower volume in the left temporal-parietal-occipital cortex in young patients with type 1 diabetes than in controls. The study also indicated that in pediatric patients, higher severity of type 1 diabetes presentation correlates with greater structural differences in the brain at about 3 months following diagnosis. The investigators found that among study patients with type 1 diabetes, an association existed between the presence of diabetic ketoacidosis at presentation and reduced radial, axial, and mean diffusivity in the major white matter tracts on magnetic resonance imaging (MRI). In those with higher glycated hemoglobin (HbA1c) levels, hippocampal, thalamic, and cerebellar white matter volumes were lower, as was right posterior parietal cortical thickness, while right occipital cortical thickness was greater. Patients in the study were aged 7-17 years. [43]
Beta cells are vulnerable to more than just bad genes, which may explain the associations between type 2 diabetes and environmental factors that aren't related to how much fat a body has or where it is stored. Beta cells carry vitamin D receptors on their surface, and people with vitamin D deficiency are at increased risk for type 2. Plus, several studies have shown that people with higher levels of toxic substances in their blood—such as from the PCBs found in fish fat—are at increased risk of type 2 diabetes, though a cause-and-effect relationship hasn't been proved. (Toxic substances and vitamin D have also been implicated in type 1 diabetes, but the disease mechanism may be unrelated to what's going on in type 2.)
There is evidence that certain emotions can promote type 2 diabetes. A recent study found that depression seems to predispose people to diabetes. Other research has tied emotional stress to diabetes, though the link hasn't been proved. Researchers speculate that the emotional connection may have to do with the hormone cortisol, which floods the body during periods of stress. Cortisol sends glucose to the blood, where it can fuel a fight-or-flight response, but overuse of this system may lead to dysfunction.
About 84 million adults in the US (more than 1 out of 3) have prediabetes, and about 90% do not know they have it until a routine blood test is ordered, or symptoms of type 2 diabetes develop. For example, excessive thirst, frequent urination, and unexplained weight loss. If you have prediabetes also it puts you at risk for heart attack, stroke, and type 2 diabetes.
Apart from these medications, treating diabetes effectively means taking a well-rounded approach: You’ll need to eat well, exercise, and manage stress, because all these factors can affect your blood sugar levels. Staying healthy with diabetes also requires caring for yourself — like protecting your feet, practicing oral hygiene, and tending to your mental health.
Although urine can also be tested for the presence of glucose, checking urine is not a good way to monitor treatment or adjust therapy. Urine testing can be misleading because the amount of glucose in the urine may not reflect the current level of glucose in the blood. Blood glucose levels can get very low or reasonably high without any change in the glucose levels in the urine.
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.

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.


WELL-CONTROLLED DIABETES MELLITUS: Daily blood sugar abstracted from the records of a patient whose DM is well controlled (hemoglobin A1c=6.4). The average capillary blood glucose level is 104 mg/dL, and the standard deviation is 19. Sixty-five percent of the readings are between 90 and 140 mg/dL; the lowest blood sugar is 67 mg/dL (on April 15) and the highest is about 190 (on March 21).
Intensive blood sugar lowering (HbA1c<6%) as opposed to standard blood sugar lowering (HbA1c of 7–7.9%) does not appear to change mortality.[74][75] The goal of treatment is typically an HbA1c of 7 to 8% or a fasting glucose of less than 7.2 mmol/L (130 mg/dl); however these goals may be changed after professional clinical consultation, taking into account particular risks of hypoglycemia and life expectancy.[59][76][77] Despite guidelines recommending that intensive blood sugar control be based on balancing immediate harms with long-term benefits, many people – for example people with a life expectancy of less than nine years who will not benefit, are over-treated.[78]

Type 1 diabetes is partly inherited, with multiple genes, including certain HLA genotypes, known to influence the risk of diabetes. In genetically susceptible people, the onset of diabetes can be triggered by one or more environmental factors,[41] such as a viral infection or diet. Several viruses have been implicated, but to date there is no stringent evidence to support this hypothesis in humans.[41][42] Among dietary factors, data suggest that gliadin (a protein present in gluten) may play a role in the development of type 1 diabetes, but the mechanism is not fully understood.[43][44]
Diabetes mellitus is linked with an increased risk of heart attacks, strokes, poor blood circulation to the legs and damage to the eyes, feet and kidneys. Early diagnosis and strict control of blood sugar, blood pressure and cholesterol levels can help to prevent or delay these complications associated with diabetes. Maintaining a healthy lifestyle (regular exercise, eating healthily and maintaining a healthy weight) is important in reducing the risk of developing type 2 diabetes.
A growing number of people in the U.S. and throughout the world are overweight and more prone to develop Type 2 diabetes, particularly if they have the genetics for it. "Type 2 diabetes can be caused by genetic inheritance, but by far the obesity epidemic has created massive increases in the occurrence of Type 2 diabetes. This is due to the major insulin resistance that is created by obesity," Gage says.
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.
Some patients with type 2 DM can control their disease with a calorically restricted diet (for instance 1600 to 1800 cal/day), regular aerobic exercise, and weight loss. Most patients, however, require the addition of some form of oral hypoglycemic drug or insulin. Oral agents to control DM include sulfonylurea drugs (such as glipizide), which increase pancreatic secretion of insulin; biguanides or thiazolidinediones (such as metformin or pioglitazone), which increase cellular sensitivity to insulin; or a-glucosidase inhibitors (such as acarbose), which decrease the absorption of carbohydrates from the gastrointestinal tract. Both types of diabetics also may be prescribed pramlintide (Symlin), a synthetic analog of human amylin, a hormone manufactured in the pancreatic beta cells. It enhances postprandial glucose control by slowing gastric emptying, decreasing postprandial glucagon concentrations, and regulating appetite and food intake; thus pramlintide is helpful for patients who do not achieve optimal glucose control with insulin and/or oral antidiabetic agents. When combinations of these agents fail to normalize blood glucose levels, insulin injections are added. Tight glucose control can reduce the patient’s risk of many of the complications of the disease. See: illustration

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.
Type 1 diabetes occurs when your immune system, the body’s system for fighting infection, attacks and destroys the insulin-producing beta cells of the pancreas. Scientists think type 1 diabetes is caused by genes and environmental factors, such as viruses, that might trigger the disease. Studies such as TrialNet are working to pinpoint causes of type 1 diabetes and possible ways to prevent or slow the disease.
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]
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.
Diabetes mellitus is classified into four broad categories: type 1, type 2, gestational diabetes, and "other specific types".[11] The "other specific types" are a collection of a few dozen individual causes.[11] Diabetes is a more variable disease than once thought and people may have combinations of forms.[37] The term "diabetes", without qualification, usually refers to diabetes mellitus.
When your blood sugar is out of whack, you just don’t feel well, says Cypress, and might become more short-tempered. In fact, high blood sugar can mimic depression-like symptoms. “You feel very tired, you don’t feel like doing anything, you don’t want to go out, you just want to sleep,” Cypress says. She’ll see patients who think they need to be treated for depression, but then experience mood improvement after their blood sugar normalizes.
Vulvodynia or vaginal pain, genital pain is a condition in which women have chronic vulvar pain with no known cause. There are two types of vulvodynia, generalized vulvodynia and vulvar vestibulitis. Researchers are trying to find the causes of vulvodynia, for example, nerve irritation, genetic factors, hypersensitivity to yeast infections, muscle spasms, and hormonal changes.The most common symptoms of vaginal pain (vulvodynia) is burning, rawness, itching, stinging, aching, soreness, and throbbing. There are a variety of treatments that can ease the symptoms of vulvodynia (vaginal pain).
Type 2 diabetes was once rare in children and adolescents but has recently become more common. However, it usually begins in people older than 30 and becomes progressively more common with age. About 26% of people older than 65 have type 2 diabetes. People of certain racial and ethnic backgrounds are at increased risk of developing type 2 diabetes: blacks, Asian Americans, American Indians, and people of Spanish or Latin American ancestry who live in the United States have a twofold to threefold increased risk as compared with whites. Type 2 diabetes also tends to run in families.
Diabetes mellitus is a diagnostic term for a group of disorders characterized by abnormal glucose homeostasis resulting in elevated blood sugar. It is among the most common of chronic disorders, affecting up to 5–10% of the adult population of the Western world. The prevalence of diabetes is increasing dramatically; it has been estimated that the worldwide prevalence will increase by more than 50% between the years 2000 and 2030 (Wild et al., 2004). It is clearly established that diabetes mellitus is not a single disease, but a genetically heterogeneous group of disorders that share glucose intolerance in common. The concept of genetic heterogeneity (i.e. that different genetic and/or environmental etiologic factors can result in similar phenotypes) has significantly altered the genetic analysis of this common disorder.

Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly.[2] As the disease progresses, a lack of insulin may also develop.[12] This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes".[2] The most common cause is excessive body weight and insufficient exercise.[2]

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.
Can type 2 diabetes be prevented? It is possible to reduce the risk of developing type 2 diabetes, although the underlying risk of type 2 diabetes depends strongly on genetic factors. But there was less type 2 diabetes around some years ago when people had a more active life and didn’t eat a modern Western diet. So it is fair to say that risk of getting type 2 diabetes is based on a genetic predisposition that is aggravated by lifestyle. Type 2 diabetes is associated with obesity, as well as a variety of environmental factors. To lower the risk of developing type 2 diabetes (as well as other diseases), it is highly recommended to exercise often, eat healthily, and maintain a healthy weight. 

The typical symptoms of diabetes mellitus are the three “polys:” polyuria, polydipsia, and polyphagia. Because of insulin deficiency, the assimilation and storage of glucose in muscle adipose tissues, and the liver is greatly diminished. This produces an accumulation of glucose in the blood and creates an increase in its osmolarity. In response to this increased osmotic pressure there is depletion of intracellular water and osmotic diuresis. The water loss creates intense thirst and increased urination. The increased appetite (polyphagia) is not as clearly understood. It may be the result of the body's effort to increase its supply of energy foods even though eating more carbohydrates in the absence of sufficient insulin does not meet the energy needs of the cells.
Dietary factors also influence the risk of developing type 2 diabetes. Consumption of sugar-sweetened drinks in excess is associated with an increased risk.[32][33] The type of fats in the diet are important, with saturated fats and trans fatty acids increasing the risk, and polyunsaturated and monounsaturated fat decreasing the risk.[26] Eating a lot of white rice appears to play a role in increasing risk.[34] A lack of exercise is believed to cause 7% of cases.[35] Persistent organic pollutants may play a role.[36]
Although many of the symptoms of type 1 and type 2 diabetes are similar, they present in very different ways. Many people with type 2 diabetes won’t have symptoms for many years. Then often the symptoms of type 2 diabetes develop slowly over the course of time. Some people with type 2 diabetes have no symptoms at all and don’t discover their condition until complications develop.

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.


Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain's main source of fuel. If you have diabetes, no matter what type, it means you have too much glucose in your blood, although the causes may differ. Too much glucose can lead to serious health problems.
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