Persons with diabetes are prone to infection, delayed healing, and vascular disease. The ease with which poorly controlled diabetic persons develop an infection is thought to be due in part to decreased chemotaxis of leukocytes, abnormal phagocyte function, and diminished blood supply because of atherosclerotic changes in the blood vessels. An impaired blood supply means a deficit in the protective defensive cells transported in the blood. Excessive glucose allows organisms to grow out of control.
If you’re getting a good night’s rest but still find yourself so tired you can barely function, it’s definitely worth mentioning to your doctor. Diabetes often wreaks havoc on a person’s normal blood sugar levels, causing fatigue in the process. In later stages, the tissue death associated with untreated diabetes can also limit circulation, meaning oxygenated blood isn’t being effectively transported to your vital organs, making your body work harder and tiring you out along the way.
As of 2015, an estimated 415 million people had diabetes worldwide,[8] with type 2 DM making up about 90% of the cases.[16][17] This represents 8.3% of the adult population,[17] with equal rates in both women and men.[18] As of 2014, trends suggested the rate would continue to rise.[19] Diabetes at least doubles a person's risk of early death.[2] From 2012 to 2015, approximately 1.5 to 5.0 million deaths each year resulted from diabetes.[8][9] The global economic cost of diabetes in 2014 was estimated to be US$612 billion.[20] In the United States, diabetes cost $245 billion in 2012.[21]
It is also important to note that currently one third of those who have IGT are in the productive age between 20-39 yr and, therefore, are likely to spend many years at high risk of developing diabetes and/or complications of diabetes1. Some persons with prediabetes experience reactive hypoglycaemia 2-3 hours after a meal. This is a sign of impaired insulin metabolism indicative of impending occurrence of diabetes. Therefore, periodic medical check-up in people with such signs or risk factors for diabetes would reduce the hazards involved in having undiagnosed diabetes. It would help improve the health status of a large number of people who otherwise would be silent sufferers from the metabolic aberrations associated with diabetes.
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. 
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).
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.
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
Persons with diabetes who take insulin must be careful about indulging in unplanned exercise. Strenuous physical activity can rapidly lower their blood sugar and precipitate a hypoglycemic reaction. For a person whose blood glucose level is over 250 mg/dl, the advice would be not to exercise at all. At this range, the levels of insulin are too low and the body would have difficulty transporting glucose into exercising muscles. The result of exercise would be a rise in blood glucose levels.
Sequelae. The long-term consequences of diabetes mellitus can involve both large and small blood vessels throughout the body. That in large vessels is usually seen in the coronary arteries, cerebral arteries, and arteries of the lower extremities and can eventually lead to myocardial infarction, stroke, or gangrene of the feet and legs. atherosclerosis is far more likely to occur in persons of any age who have diabetes than it is in other people. This predisposition is not clearly understood. Some believe that diabetics inherit the tendency to develop severe atherosclerosis as well as an aberration in glucose metabolism, and that the two are not necessarily related. There is strong evidence to substantiate the claim that optimal control will mitigate the effects of diabetes on the microvasculature, particularly in the young and middle-aged who are at greatest risk for developing complications involving the arterioles. Pathologic changes in the small blood vessels serving the kidney lead to nephrosclerosis, pyelonephritis, and other disorders that eventually result in renal failure. Many of the deaths of persons with type 1 diabetes are caused by renal failure.
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.
Injections of insulin may either be added to oral medication or used alone.[24] Most people do not initially need insulin.[13] When it is used, a long-acting formulation is typically added at night, with oral medications being continued.[23][24] Doses are then increased to effect (blood sugar levels being well controlled).[24] When nightly insulin is insufficient, twice daily insulin may achieve better control.[23] The long acting insulins glargine and detemir are equally safe and effective,[98] and do not appear much better than neutral protamine Hagedorn (NPH) insulin, but as they are significantly more expensive, they are not cost effective as of 2010.[99] In those who are pregnant insulin is generally the treatment of choice.[23]

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.
1. Monitoring of blood glucose status. In the past, urine testing was an integral part of the management of diabetes, but it has largely been replaced in recent years by self monitoring of blood glucose. Reasons for this are that blood testing is more accurate, glucose in the urine shows up only after the blood sugar level is high, and individual renal thresholds vary greatly and can change when certain medications are taken. As a person grows older and the kidney is less able to eliminate sugar in the urine, the renal threshold rises and less sugar is spilled into the urine. The position statement of the American Diabetes Association on Tests of Glycemia in Diabetes notes that urine testing still plays a role in monitoring in type 1 and gestational diabetes, and in pregnancy with pre-existing diabetes, as a way to test for ketones. All people with diabetes should test for ketones during times of acute illness or stress and when blood glucose levels are consistently elevated.

The United Kingdom Prospective Diabetes Study (UKPDS) was a clinical study conducted by Z that was published in The Lancet in 1998. Around 3,800 people with type 2 diabetes were followed for an average of ten years, and were treated with tight glucose control or the standard of care, and again the treatment arm had far better outcomes. This confirmed the importance of tight glucose control, as well as blood pressure control, for people with this condition.[86][132][133]
“It’s not like you wake up one day and all of a sudden you’re thirsty, hungry, and [going to the bathroom] all the time,” says Melissa Joy Dobbins, RD, a certified diabetes educator in Illinois and a spokesperson for the American Association of Diabetes Educators. “It picks up gradually.” Indeed, “most people are unaware that they have diabetes in its early or even middle phases,” says Aaron Cypess, MD, assistant professor of medicine at Harvard Medical School and staff physician at Joslin Diabetes Center. Just because you’re not keyed in doesn’t mean you’re immune from problems associated with diabetes, he adds. The longer you go without controlling diabetes, the greater your risk for heart disease, kidney disease, amputation, blindness, and other serious complications. “We recommend that people with risk factors for diabetes, such as a family history or being overweight, get evaluated on a regular basis,” Dr. Cypess says. If you’ve been feeling off, talk to your doctor about getting a simple blood test that can diagnose the disease. And pay attention to these subtle signs and symptoms of diabetes.

Type 1 diabetes mellitus can occur at any age, but incidence rates generally increase with age until midpuberty and then decline. [32] Onset in the first year of life, although unusual, can occur, so type 1 diabetes mellitus must be considered in any infant or toddler, because these children have the greatest risk for mortality if diagnosis is delayed. (Because diabetes is easily missed in an infant or preschool-aged child, if in doubt, check the urine for glucose.) Symptoms in infants and toddlers may include the following:
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]
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.
The classic symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), and weight loss.[23] Other symptoms that are commonly present at diagnosis include a history of blurred vision, itchiness, peripheral neuropathy, recurrent vaginal infections, and fatigue.[13] Many people, however, have no symptoms during the first few years and are diagnosed on routine testing.[13] 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).[13]
Dietary factors also influence the risk of developing type 2 DM. Consumption of sugar-sweetened drinks in excess is associated with an increased risk.[46][47] The type of fats in the diet is also important, with saturated fat and trans fats increasing the risk and polyunsaturated and monounsaturated fat decreasing the risk.[45] Eating lots of white rice, and other starches, also may increase the risk of diabetes.[48] A lack of physical activity is believed to cause 7% of cases.[49]
Diabetes insipidus is considered very rare in less 20,000 cases diagnosed per year. Diabetes mellitus is more common, with type 2 diabetes being more common than type 1. There are more than 3 million cases of type 2 diabetes. Unlike diabetes mellitus, diabetes insipidus is not treated by controlling insulin levels. Depending on your symptoms, your doctor may prescribe a low-salt diet, hormone therapy, or have you increase your water intake. 
A random blood sugar of greater than 11.1 mmol/l (200 mg/dl) in association with typical symptoms[23] or a glycated hemoglobin (HbA1c) of ≥ 48 mmol/mol (≥ 6.5 DCCT %) is another method of diagnosing diabetes.[10] In 2009 an International Expert Committee that included representatives of the American Diabetes Association (ADA), the International Diabetes Federation (IDF), and the European Association for the Study of Diabetes (EASD) recommended that a threshold of ≥ 48 mmol/mol (≥ 6.5 DCCT %) should be used to diagnose diabetes.[48] This recommendation was adopted by the American Diabetes Association in 2010.[49] Positive tests should be repeated unless the person presents with typical symptoms and blood sugars >11.1 mmol/l (>200 mg/dl).[48]

"Brittle" diabetes, also known as unstable diabetes or labile diabetes, is a term that was traditionally used to describe the dramatic and recurrent swings in glucose levels, often occurring for no apparent reason in insulin-dependent diabetes. This term, however, has no biologic basis and should not be used.[39] Still, type 1 diabetes can be accompanied by irregular and unpredictable high blood sugar levels, frequently with ketosis, and sometimes with serious low blood sugar levels. Other complications include an impaired counterregulatory response to low blood sugar, infection, gastroparesis (which leads to erratic absorption of dietary carbohydrates), and endocrinopathies (e.g., Addison's disease).[39] These phenomena are believed to occur no more frequently than in 1% to 2% of persons with type 1 diabetes.[40]

People with T2D produce insulin, but their bodies don’t use it correctly; this is referred to as being insulin resistant. People with type 2 diabetes may also be unable to produce enough insulin to handle the glucose in their body. In these instances, insulin is needed to allow the glucose to travel from the bloodstream into our cells, where it’s used to create energy.
Yet carbs are processed differently in the body based on their type: While simple carbs are digested and metabolized quickly, complex carbs take longer to go through this system, resulting in more stable blood sugar. “It comes down to their chemical forms: A simple carbohydrate has a simpler chemical makeup, so it doesn’t take as much for it to be digested, whereas the complex ones take a little longer,” Grieger explains.
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)
All you need to know about insulin sensitivity factor Insulin sensitivity factor is a measurement that describes how blood sugar levels are affected by taking 1 unit of insulin. It can help a person with type 1 diabetes regulate their blood sugar levels. Learn more about what insulin sensitivity factor is, who should test and when, and what the results mean. Read now
Since cardiovascular disease is a serious complication associated with diabetes, some have recommended blood pressure levels below 130/80 mmHg.[89] However, evidence supports less than or equal to somewhere between 140/90 mmHg to 160/100 mmHg; the only additional benefit found for blood pressure targets beneath this range was an isolated decrease in stroke risk, and this was accompanied by an increased risk of other serious adverse events.[90][91] A 2016 review found potential harm to treating lower than 140 mmHg.[92] Among medications that lower blood pressure, angiotensin converting enzyme inhibitors (ACEIs) improve outcomes in those with DM while the similar medications angiotensin receptor blockers (ARBs) do not.[93] Aspirin is also recommended for people with cardiovascular problems, however routine use of aspirin has not been found to improve outcomes in uncomplicated diabetes.[94]
All you need to know about insulin sensitivity factor Insulin sensitivity factor is a measurement that describes how blood sugar levels are affected by taking 1 unit of insulin. It can help a person with type 1 diabetes regulate their blood sugar levels. Learn more about what insulin sensitivity factor is, who should test and when, and what the results mean. Read now

Over time, a prolonged exposure to high blood sugar can damage the nerves throughout the body — a condition called diabetic neuropathy. Some people may not have any symptoms of the damage, while others may notice numbness, tingling, or pain in the extremities. “At the beginning, [diabetic neuropathy] usually starts in the feet and then it progresses upward,” says Dr. Ovalle. Although most common in people who have had type 2 diabetes for 25 years or more, it can occur in people who have prediabetes as well. In some studies, almost 50 percent of unexplained peripheral neuropathy [in the extremities], whether painful or otherwise, turns out to be caused by prediabetes or diabetes, says Dr. Einhorn.
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