According to the American Diabetes Association, a child has a 1 in 7 risk of getting type 2 diabetes if his/her parent was diagnosed with type 2 diabetes before the age of 50, and a 1 in 13 risk of developing it if the parent was diagnosed after the age of 50. To see if you may be at risk for diabetes, consider taking this short and simple Type 2 Diabetes Risk Test from the ADA.
According to the Mayo Clinic, your risk of developing type 2 diabetes increases as you age. Your risk goes up after age 45 in particular. However, the incidence of type 2 diabetes is increasing dramatically among children, adolescents, and younger adults. Likely factors include reduced exercise, decreased muscle mass, and weight gain as you age. Type 1 diabetes is usually diagnosed by the age of 30.
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.
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.
The ADA recommends using patient age as one consideration in the establishment of glycemic goals, with different targets for preprandial, bedtime/overnight, and hemoglobin A1c (HbA1c) levels in patients aged 0-6, 6-12, and 13-19 years. [4] Benefits of tight glycemic control include not only continued reductions in the rates of microvascular complications but also significant differences in cardiovascular events and overall mortality.

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. 

Damage to small blood vessels can affect the eyes, kidneys, and nerves. Damage to eyes, specifically the retina, is called diabetic retinopathy and is the leading cause of blindness. Damage to the kidneys, called diabetic nephropathy, can lead to kidney failure and the need for dialysis. Damage to the nerves that supply the legs and arms and gastrointestinal tract is called diabetic neuropathy. Some people with diabetes who develop peripheral neuropathy (damage to the nerves in the legs) and have poor blood flow to the legs may eventually need an amputation.
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.
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.
Jump up ^ Pignone M, Alberts MJ, Colwell JA, Cushman M, Inzucchi SE, Mukherjee D, Rosenson RS, Williams CD, Wilson PW, Kirkman MS (June 2010). "Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation". Diabetes Care. 33 (6): 1395–402. doi:10.2337/dc10-0555. PMC 2875463. PMID 20508233.

Jump up ^ Boussageon, R; Bejan-Angoulvant, T; Saadatian-Elahi, M; Lafont, S; Bergeonneau, C; Kassaï, B; Erpeldinger, S; Wright, JM; Gueyffier, F; Cornu, C (2011-07-26). "Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials". The BMJ. 343: d4169. doi:10.1136/bmj.d4169. PMC 3144314. PMID 21791495.
Not all people with diabetes need drug therapy. A healthy eating plan and exercise alone can be enough if the person makes significant lifestyle changes. Other signs, symptoms, and complications also may need treatment. For example, nutritional deficiencies should be corrected, heart or kidney disease may need to be treated, and vision must be checked for eye problems like diabetic retinopathy.
Some risks of the keto diet include low blood sugar, negative medication interactions, and nutrient deficiencies. (People who should avoid the keto diet include those with kidney damage or disease, women who are pregnant or breast-feeding, and those with or at a heightened risk for heart disease due to high blood pressure, high cholesterol, or family history. (40)
It’s no surprise that most people could stand to drink more water. In fact, the majority of Americans are drinking less than half of the recommended eight glasses of water each day. However, if you’re finding yourself excessively thirsty, that could be a sign that you’re dealing with dangerously high blood sugar. Patients with diabetes often find themselves extremely thirsty as their bodies try to flush out excess sugar in their blood when their own insulin production just won’t cut it. If you’re parched, instead of turning to a sugary drink, quench that thirst with one of the 50 Best Detox Waters for Fat Burning and Weight Loss!
A: There are two scenarios to consider here, pregnant patients who have diabetes and pregnant patients who have gestational diabetes. Gestational diabetes describes hyperglycemia discovered during pregnancy. This hyperglycemia often corrects itself after pregnancy, but women who experience gestational diabetes are at higher for developing type-2 diabetes later in life when compared to women who experience no hyperglycemia during pregnancy. Regardless of the type of diabetes a pregnant patient has, her physician will closely monitor her disease and its response to therapy. Proper glucose control is important not only for the health of the mother, but also her developing child.
Jump up ^ Haw JS, Galaviz KI, Straus AN, Kowalski AJ, Magee MJ, Weber MB, Wei J, Narayan KM, Ali MK (December 2017). "Long-term Sustainability of Diabetes Prevention Approaches: A Systematic Review and Meta-analysis of Randomized Clinical Trials". JAMA Internal Medicine. 177 (12): 1808–1817. doi:10.1001/jamainternmed.2017.6040. PMC 5820728. PMID 29114778.
The good news is that behavior still seems to help shape whether someone with the genetic disposition actually develops type 2—and that changes in diet and exercise can sometimes be enough to ward off the disease. "People sometimes have the misconception that if we say something is genetic, then they can't do anything about preventing diabetes and its complications," says Hanis. But he notes that in a landmark study, lifestyle interventions prevented or delayed type 2 in nearly 60 percent of people at high risk. "If we focus on changing the environment, we can prevent diabetes," he says. "As we understand the genetics, we can prevent more of it."
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]
Culturally appropriate education may help people with type 2 diabetes control their blood sugar levels, for up to 24 months.[89] If changes in lifestyle in those with mild diabetes has not resulted in improved blood sugars within six weeks, medications should then be considered.[23] There is not enough evidence to determine if lifestyle interventions affect mortality in those who already have DM2.[62]

Onset of type 2 diabetes can be delayed or prevented through proper nutrition and regular exercise.[60][61] Intensive lifestyle measures may reduce the risk by over half.[24][62] The benefit of exercise occurs regardless of the person's initial weight or subsequent weight loss.[63] High levels of physical activity reduce the risk of diabetes by about 28%.[64] Evidence for the benefit of dietary changes alone, however, is limited,[65] with some evidence for a diet high in green leafy vegetables[66] and some for limiting the intake of sugary drinks.[32] In those with impaired glucose tolerance, diet and exercise either alone or in combination with metformin or acarbose may decrease the risk of developing diabetes.[24][67] Lifestyle interventions are more effective than metformin.[24] A 2017 review found that, long term, lifestyle changes decreased the risk by 28%, while medication does not reduce risk after withdrawal.[68] While low vitamin D levels are associated with an increased risk of diabetes, correcting the levels by supplementing vitamin D3 does not improve that risk.[69]


Type 2 diabetes: Type 2 diabetes affects the way the body uses insulin. While the body still makes insulin, unlike in type I, the cells in the body do not respond to it as effectively as they once did. This is the most common type of diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases, and it has strong links with obesity.
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. 

In addition to the problems with an increase in insulin resistance, the release of insulin by the pancreas may also be defective and suboptimal. In fact, there is a known steady decline in beta cell production of insulin in type 2 diabetes that contributes to worsening glucose control. (This is a major factor for many patients with type 2 diabetes who ultimately require insulin therapy.) Finally, the liver in these patients continues to produce glucose through a process called gluconeogenesis despite elevated glucose levels. The control of gluconeogenesis becomes compromised.


Jump up ^ Cheng J, Zhang W, Zhang X, Han F, Li X, He X, Li Q, Chen J (May 2014). "Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on all-cause mortality, cardiovascular deaths, and cardiovascular events in patients with diabetes mellitus: a meta-analysis". JAMA Internal Medicine. 174 (5): 773–85. doi:10.1001/jamainternmed.2014.348. PMID 24687000.
In the exchange system, foods are divided into six food groups (starch, meat, vegetable, fruit, milk, and fat) and the patient is taught to select items from each food group as ordered. Items in each group may be exchanged for each other in specified portions. The patient should avoid concentrated sweets and should increase fiber in the diet. Special dietetic foods are not necessary. Patient teaching should emphasize that a diabetic diet is a healthy diet that all members of the family can follow.
The classic oral glucose tolerance test measures blood glucose levels five times over a period of three hours. Some physicians simply get a baseline blood sample followed by a sample two hours after drinking the glucose solution. In a person without diabetes, the glucose levels rise and then fall quickly. In someone with diabetes, glucose levels rise higher than normal and fail to come back down as fast.
a broadly applied term used to denote a complex group of syndromes that have in common a disturbance in the oxidation and utilization of glucose, which is secondary to a malfunction of the beta cells of the pancreas, whose function is the production and release of insulin. Because insulin is involved in the metabolism of carbohydrates, proteins and fats, diabetes is not limited to a disturbance of glucose homeostasis alone.
The brain depends on glucose as a fuel. As glucose levels drop below 65 mg/dL (3.2 mmol/L) counterregulatory hormones (eg, glucagon, cortisol, epinephrine) are released, and symptoms of hypoglycemia develop. These symptoms include sweatiness, shaking, confusion, behavioral changes, and, eventually, coma when blood glucose levels fall below 30-40 mg/dL.
People with type 1 diabetes sometimes receive transplantation of an entire pancreas or of only the insulin-producing cells from a donor pancreas. This procedure may allow people with type 1 diabetes mellitus to maintain normal glucose levels. However, because immunosuppressant drugs must be given to prevent the body from rejecting the transplanted cells, pancreas transplantation is usually done only in people who have serious complications due to diabetes or who are receiving another transplanted organ (such as a kidney) and will require immunosuppressant drugs anyway.
There are a number of rare cases of diabetes that arise due to an abnormality in a single gene (known as monogenic forms of diabetes or "other specific types of diabetes").[10][13] These include maturity onset diabetes of the young (MODY), Donohue syndrome, and Rabson–Mendenhall syndrome, among others.[10] Maturity onset diabetes of the young constitute 1–5% of all cases of diabetes in young people.[38]
Good metabolic control can delay the onset and progression of diabetic retinopathy. Loss of vision and blindness in persons with diabetes can be prevented by early detection and treatment of vision-threatening retinopathy: regular eye examinations and timely intervention with laser treatment, or through surgery in cases of advanced retinopathy. There is evidence that, even in developed countries, a large proportion of those in need is not receiving such care due to lack of public and professional awareness, as well as an absence of treatment facilities. In developing countries, in many of which diabetes is now common, such care is inaccessible to the majority of the population.

Type 2 diabetes is different. A person with type 2 diabetes still produces insulin but the body doesn't respond to it normally. Glucose is less able to enter the cells and do its job of supplying energy (a problem called insulin resistance). This raises the blood sugar level, so the pancreas works hard to make even more insulin. Eventually, this strain can make the pancreas unable to produce enough insulin to keep blood sugar levels normal.
Then, your blood sugar levels get too high. High blood sugar can have a deleterious effect on many parts of your body, including heart, blood vessels, nerves, eyes, and kidneys. Those who are overweight, don’t exercise enough, or have a history of type 2 diabetes in their family are more likely to get the disease. Maintaining a healthy weight, eating a healthy diet, and getting enough exercise can prevent type 2 diabetes. If you have a history of diabetes in your family, or if you are overweight, stay ahead of the disease by making healthy lifestyle choices and changing your diet.
“I don’t think that anybody has put their finger on what the true cause of diabetes is, or that we’re going to find a single cause,” Grieger says. So if you’ve been diagnosed with prediabetes or have other risk factors for the disease, avoiding any one food group entirely — even sugar — won’t completely offset your risk. Rather, it’s important to prioritize proper nutrition, exercise regularly, and maintain a healthy weight — all steps the American Diabetes Association recommends for preventing type 2 diabetes.
Findings from the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) have clearly shown that aggressive and intensive control of elevated levels of blood sugar in patients with type 1 and type 2 diabetes decreases the complications of nephropathy, neuropathy, retinopathy, and may reduce the occurrence and severity of large blood vessel diseases. Aggressive control with intensive therapy means achieving fasting glucose levels between 70-120 mg/dl; glucose levels of less than 160 mg/dl after meals; and a near normal hemoglobin A1c levels (see below).
Type 2 diabetes was also previously referred to as non-insulin dependent diabetes mellitus (NIDDM), or adult-onset diabetes mellitus (AODM). In type 2 diabetes, patients can still produce insulin, but do so relatively inadequately for their body's needs, particularly in the face of insulin resistance as discussed above. In many cases this actually means the pancreas produces larger than normal quantities of insulin. A major feature of type 2 diabetes is a lack of sensitivity to insulin by the cells of the body (particularly fat and muscle cells).
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."
Patient Education. Successful management of diabetes requires that the patient actively participate in and be committed to the regimen of care. The problem of poor control can cause serious or even deadly short-term and long-term complications, with devastating effects on the patient's longevity and sense of well being. There are many teaching aids available to help persons with diabetes understand their disease and comply with prescribed therapy. In general, a patient education program should include the following components:

observations The onset of type 1 diabetes mellitus is sudden in children. Type 2 diabetes often begins insidiously. Characteristically the course is progressive and includes polyuria, polydipsia, weight loss, polyphagia, hyperglycemia, and glycosuria. The eyes, kidneys, nervous system, skin, and circulatory system may be affected by the long-term complications of either type of diabetes; infections are common; and atherosclerosis often develops. In type 1 diabetes mellitus, when no endogenous insulin is being secreted, ketoacidosis is a constant danger. The diagnosis is confirmed by fasting plasma glucose and history.
Excess glucose in the blood can damage small blood vessels in the nerves causing a tingling sensation or pain in the fingers, toes and limbs. Nerves that lie outside of the central nervous system may also be damaged, which is referred to as peripheral neuropathy. If nerves of the gastrointestinal tract are affected, this may cause vomiting, constipation and diarrhea.
Most pediatric patients with diabetes have type 1 diabetes mellitus (T1DM) and a lifetime dependence on exogenous insulin. Diabetes mellitus (DM) is a chronic metabolic disorder caused by an absolute or relative deficiency of insulin, an anabolic hormone. Insulin is produced by the beta cells of the islets of Langerhans located in the pancreas, and the absence, destruction, or other loss of these cells results in type 1 diabetes (insulin-dependent diabetes mellitus [IDDM]). A possible mechanism for the development of type 1 diabetes is shown in the image below. (See Etiology.)
Low blood sugar (hypoglycemia), is common in people with type 1 and type 2 DM. Most cases are mild and are not considered medical emergencies. Effects can range from feelings of unease, sweating, trembling, and increased appetite in mild cases to more serious effects such as confusion, changes in behavior such as aggressiveness, seizures, unconsciousness, and (rarely) permanent brain damage or death in severe cases.[24][25] Moderately low blood sugar may easily be mistaken for drunkenness;[26] rapid breathing and sweating, cold, pale skin are characteristic of low blood sugar but not definitive.[27] Mild to moderate cases are self-treated by eating or drinking something high in sugar. Severe cases can lead to unconsciousness and must be treated with intravenous glucose or injections with glucagon.[28]
What his theory boils down to is that type 2 diabetes is caused not by extra fat alone, but by fat stored in the wrong places. "Virtually all the individuals [with insulin resistance] have fat accumulation in liver and muscle," Shulman says, where it may disrupt normal biological processes, leading to insulin resistance. "If you can understand this, you can ideally come up with new ways to prevent insulin resistance and type 2 diabetes."
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.
Because type 2 diabetes is linked to high levels of sugar in the blood, it may seem logical to assume that eating too much sugar is the cause of the disease. But of course, it’s not that simple. “This has been around for years, this idea that eating too much sugar causes diabetes — but the truth is, type 2 diabetes is a multifactorial disease with many different types of causes,” says Lynn Grieger, RDN, CDE, a nutrition coach in Prescott, Arizona, and a medical reviewer for Everyday Health. “Type 2 diabetes is really complex.”

Women seem to be at a greater risk as do certain ethnic groups,[10][107] such as South Asians, Pacific Islanders, Latinos, and Native Americans.[23] This may be due to enhanced sensitivity to a Western lifestyle in certain ethnic groups.[108] Traditionally considered a disease of adults, type 2 diabetes is increasingly diagnosed in children in parallel with rising obesity rates.[10] Type 2 diabetes is now diagnosed as frequently as type 1 diabetes in teenagers in the United States.[13]


Insulin — the hormone that allows your body to regulate sugar in the blood — is made in your pancreas. Essentially, insulin resistance is a state in which the body’s cells do not use insulin efficiently. As a result, it takes more insulin than normal to transport blood sugar (glucose) into cells, to be used immediately for fuel or stored for later use. A drop in efficiency in getting glucose to cells creates a problem for cell function; glucose is normally the body’s quickest and most readily available source of energy.
Diabetes that's triggered by pregnancy is called gestational diabetes (pregnancy, to some degree, leads to insulin resistance). It is often diagnosed in middle or late pregnancy. Because high blood sugar levels in a mother are circulated through the placenta to the baby, gestational diabetes must be controlled to protect the baby's growth and development.

Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst.


Visual impairment and blindness are common sequelae of uncontrolled diabetes. The three most frequently occurring problems involving the eye are diabetic retinopathy, cataracts, and glaucoma. photocoagulation of destructive lesions of the retina with laser beams can be used to delay further progress of pathologic changes and thereby preserve sight in the affected eye.
Doctors may recommend one or more types of medications to help control diabetes. While taking medications, it's important for people with diabetes to regularly test their blood glucose levels at home. There are many different blood glucose meters available on the market. Speak to a doctor or pharmacist about these meters to help you select the best meter for your needs.
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.

Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst.

The causes of diabetes mellitus are unclear, however, there seem to be both hereditary (genetic factors passed on in families) and environmental factors involved. Research has shown that some people who develop diabetes have common genetic markers. In Type I diabetes, the immune system, the body's defense system against infection, is believed to be triggered by a virus or another microorganism that destroys cells in the pancreas that produce insulin. In Type II diabetes, age, obesity, and family history of diabetes play a role.
Diabetes mellitus type 2 is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency.[51] 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.[13] Type 1 and type 2 diabetes can typically be distinguished based on the presenting circumstances.[48] 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,[52] with C-peptide levels normal or high in type 2 diabetes, but low in type 1 diabetes.[53]
As of 2016, 422 million people have diabetes worldwide,[101] up from an estimated 382 million people in 2013[17] and from 108 million in 1980.[101] Accounting for the shifting age structure of the global population, the prevalence of diabetes is 8.5% among adults, nearly double the rate of 4.7% in 1980.[101] Type 2 makes up about 90% of the cases.[16][18] Some data indicate rates are roughly equal in women and men,[18] but male excess in diabetes has been found in many populations with higher type 2 incidence, possibly due to sex-related differences in insulin sensitivity, consequences of obesity and regional body fat deposition, and other contributing factors such as high blood pressure, tobacco smoking, and alcohol intake.[102][103]
And go easy on yourself: Sometimes you can be doing everything perfectly and your blood sugars start to creep up. Because diabetes is a progressive disease, your body slowly stops making insulin over time. If you've had diabetes for a very long time, try not to be discouraged if your doctor has to increase your medication or discusses insulin with you. Continue to do what you can to improve your health.
In type 2 diabetes, there also is a steady decline of beta cells that adds to the process of elevated blood sugars. Essentially, if someone is resistant to insulin, the body can, to some degree, increase production of insulin and overcome the level of resistance. After time, if production decreases and insulin cannot be released as vigorously, hyperglycemia develops.
By the time a person is diagnosed with type 2 diabetes, up to 50% of the beta cells in the pancreas have usually been damaged. In fact, these cells may have been declining for up to 10 years before the diagnosis. Along with raised blood pressure and elevated cholesterol levels, this predisposes the person to arterial damage years before diabetes is diagnosed. So, at the time of diagnosis, the person is already at risk for cardiovascular disease (CVD).
Most cases of diabetes involve many genes, with each being a small contributor to an increased probability of becoming a type 2 diabetic.[10] If one identical twin has diabetes, the chance of the other developing diabetes within his lifetime is greater than 90%, while the rate for nonidentical siblings is 25–50%.[13] As of 2011, more than 36 genes had been found that contribute to the risk of type 2 diabetes.[37] All of these genes together still only account for 10% of the total heritable component of the disease.[37] The TCF7L2 allele, for example, increases the risk of developing diabetes by 1.5 times and is the greatest risk of the common genetic variants.[13] Most of the genes linked to diabetes are involved in beta cell functions.[13]
In an otherwise healthy individual, blood glucose levels usually do not rise above 180 mg/dL (9 mmol/L). In a child with diabetes, blood sugar levels rise if insulin is insufficient for a given glucose load. The renal threshold for glucose reabsorption is exceeded when blood glucose levels exceed 180 mg/dL (10 mmol/L), causing glycosuria with the typical symptoms of polyuria and polydipsia. (See Pathophysiology, Clinical, and Treatment.)
Insulin is the hormone responsible for reducing blood sugar. In order for insulin to work, our tissues have to be sensitive to its action; otherwise, tissues become resistant and insulin struggles to clear out sugar from the blood. As insulin resistance sets in, the first organ to stop responding to insulin is the liver, followed by the muscles and eventually fat. How does insulin resistance begin? The root of the problem is our diet.
Talk with your doctor about connecting with a certified diabetes educator and receiving diabetes self-management education. Learning about what to eat, what your medicines do, and how to test your blood sugars are just some of the things these resources can help with. Educators can also dispel myths, create meal plans, coordinate other doctors appointments for you, and listen to your needs. They are trained to teach using a patient-centered approach. They are your advocates who specialize in diabetes. Ask your doctor today or go to the American Association of Diabetes Educators website to find someone near you. Be sure to call your insurance company to see if these services are covered, too.
a complex disorder of carbohydrate, fat, and protein metabolism that is primarily a result of a deficiency or complete lack of insulin secretion by the beta cells of the pancreas or resistance to insulin. The disease is often familial but may be acquired, as in Cushing's syndrome, as a result of the administration of excessive glucocorticoid. The various forms of diabetes have been organized into categories developed by the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus of the American Diabetes Association. Type 1 diabetes mellitus in this classification scheme includes patients with diabetes caused by an autoimmune process, dependent on insulin to prevent ketosis. This group was previously called type I, insulin-dependent diabetes mellitus, juvenile-onset diabetes, brittle diabetes, or ketosis-prone diabetes. Patients with type 2 diabetes mellitus are those previously designated as having type II, non-insulin-dependent diabetes mellitus, maturity-onset diabetes, adult-onset diabetes, ketosis-resistant diabetes, or stable diabetes. Those with gestational diabetes mellitus are women in whom glucose intolerance develops during pregnancy. Other types of diabetes are associated with a pancreatic disease, hormonal changes, adverse effects of drugs, or genetic or other anomalies. A fourth subclass, the impaired glucose tolerance group, also called prediabetes, includes persons whose blood glucose levels are abnormal although not sufficiently above the normal range to be diagnosed as having diabetes. Approximately 95% of the 18 million diabetes patients in the United States are classified as type 2, and more than 70% of those patients are obese. About 1.3 million new cases of diabetes mellitus are diagnosed in the United States each year. Contributing factors to the development of diabetes are heredity; obesity; sedentary life-style; high-fat, low-fiber diets; hypertension; and aging. See also impaired glucose tolerance, potential abnormality of glucose tolerance, previous abnormality of glucose tolerance.
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.
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