DIABETES: I CAN’T SUGARCOAT IT

What is diabetes?

Diabetes is a disease that occurs when your blood glucose, also called blood
sugar, is too high. Blood glucose is your main source of energy and comes from
the food you eat. Insulin, a hormone made by the pancreas, helps glucose from
food get into your cells to be used for energy. Sometimes your body does not
make enough—or any—insulin or does not use insulin well. Glucose then stays
in your blood and does not reach your cells.
Over time, having too much glucose in your blood can cause health problems.
Although diabetes has no cure, people can take steps to manage their diabetes
and stay healthy.
 What are the different types of diabetes?

The most common types of diabetes are type 1, type 2, and gestational
diabetes.

Type 1 diabetes

If you have type 1 diabetes, your body does not make insulin. Your immune
system attacks and destroys the cells in your pancreas that make insulin. Type
1 diabetes is usually diagnosed in children and young adults, although it can
appear at any age. People with type 1 diabetes need to take insulin every day
to stay alive.

Type 2 diabetes

If you have type 2 diabetes, your body does not make or use insulin well. You
can develop type 2 diabetes at any age, even during childhood. However, this
type of diabetes occurs most often in middle-aged and older people. Type 2 is
the most common type of diabetes.

Gestational diabetes

Gestational diabetes develops in some women when they are pregnant. Most
of the time, this type of diabetes goes away after the baby is born. However, if
you have had gestational diabetes, you have a greater chance of developing
type 2 diabetes later in life. Sometimes diabetes diagnosed during pregnancy is
type 2 diabetes.

Less common types include monogenic diabetes, which is an inherited form of

diabetes, and cystic fibrosis related diabetes.
 How common is diabetes?
As of 2015, 30.3 million people in the United States, or 9.4 percent of the
population, had diabetes. More than 1 in 4 of them did not know they had the
disease. Diabetes affects 1 in 4 people over the age of 65. About 90-95 percent
of cases in adults are type 2 diabetes.
What are the symptoms of diabetes?
increased thirst and urination
increased hunger
fatigue
blurred vision
numbness or tingling in the feet or hands
sores that do not heal
unexplained weight loss

Symptoms of type 1 diabetes can start quickly, in a matter of weeks. Symptoms

of type 2 diabetes often develop slowly—over the course of several years—and
can be so mild that you might not even notice them. Many people with type 2
diabetes have no symptoms. Some people do not find out they have the
disease until they have diabetes-related health problems, such as blurred
vision or heart problems.

Health problems people can develop with diabetes

Over time, high blood glucose leads to problems such as

heart disease
stroke
kidney disease
eye problems
dental disease
nerve damage
foot problems
 What causes type 1 diabetes?

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
are working to pinpoint causes of type 1 diabetes and possible ways to prevent
or slow the disease.

What causes type 2 diabetes?

It is the most common form of diabetes—is caused by several factors, including
lifestyle factors and genes.

Overweight, obesity, and physical inactivity

You are more likely to develop type 2 diabetes if you are not physically active
and are overweight or have obesity. Extra weight sometimes causes insulin
resistance and is common in people with type 2 diabetes. The location of body
fat also makes a difference. Extra belly fat is linked to insulin resistance, type 2
diabetes, and heart and blood vessel disease. To see if your weight puts you at
risk for type 2 diabetes, check out these body mass index charts (BMI).

Insulin resistance

Type 2 diabetes usually begins with insulin resistance, a condition in which

muscle, liver, and fat cells do not use insulin well. As a result, your body needs
more insulin to help glucose enter cells. At first, the pancreas makes more
insulin to keep up with the added demand. Over time, the pancreas cannot
make enough insulin, and blood glucose levels rise.

Genes and family history

As in type 1 diabetes, certain genes may make you more likely to develop type
2 diabetes. The disease tends to run in families and occurs more often in these
racial/ethnic groups:

African Americans
Alaska Natives
American Indians
Asian Americans
Hispanics/Latinos
 Native Hawaiians
Pacific Islanders
Who is more likely to develop type 2 diabetes?

You are more likely to develop type 2 diabetes if you are age 45 or older, have
a family history of diabetes, or are overweight. Physical inactivity, race, and
certain health problems such as high blood pressure also affect your chance of
developing type 2 diabetes. You also more likely to develop type 2 diabetes if
you have prediabetes or had gestational diabetes when you were pregnant.

What is monogenic diabetes?

Monogenic diabetes is caused by mutations, or changes, in a single

gene. These changes are usually passed through families, but
sometimes the gene mutation happens on its own. Most of these
gene mutations cause diabetes by making the pancreas less able to
make insulin. The most common types of monogenic diabetes are
neonatal diabetes and maturity-onset diabetes of the young (MODY).
Neonatal diabetes occurs in the first 6 months of life. Doctors usually
diagnose MODY during adolescence or early adulthood, but
sometimes the disease is not diagnosed until later in life.

What is cystic diabetes?

It produces thick mucus that causes scarring in the pancreas. This

scarring can prevent the pancreas from making enough insulin.

What is hemochromatosis?

It causes the body to store too much iron. If the disease is not treated, iron can
build up in and damage the pancreas and other organs.

What happens when the pancreas is damages/removed?

Pancreatitis, pancreatic cancer, and trauma can all harm the beta cells or make
them less able to produce insulin, resulting in diabetes. If the damaged
pancreas is removed, diabetes will occur due to the loss of the beta cells.
 How to reduce chances of type 2 diabetes?

Lose weight and keep it off. You may be able to prevent or delay
diabetes by losing 5 to 7 percent of your starting weight. 1 For instance, if
you weigh 200 pounds, your goal would be to lose about 10 to 14
pounds.
Move more. Get at least 30 minutes of physical activity 5 days a week. If
you have not been active, talk with your health care professional about
which activities are best. Start slowly to build up to your goal.
Eat healthy foods most of the time. Eat smaller portions to reduce the
number of calories you eat each day and help you lose weight. Choosing
foods with less fat is another way to reduce calories. Drink water instead
of sweetened beverages.

Who should be tested for diabetes?

Anyone who has symptoms of diabetes should be tested for the disease.
Some people will not have any symptoms but may have risk factor for
type 2 diabetes and need to be tested. Most pregnant women should
also be tested for gestational diabetes. Testing helps doctors find
diabetes sooner, so they can work with their patients to manage the
disease and prevent health problems.

Type 1 diabetes

Doctors often diagnose type 1 diabetes in children and young adults when they
have diabetes symptoms, such as feeling thirsty and having to urinate more
often, or if they may have diabetes ketoacidosis. Symptoms in adults may be
less specific.

Type 1 diabetes can run in families. A study offers free testing to relatives of
people with type 1 diabetes, even if the relatives do not have symptoms.
 Type 2 diabetes

Experts recommend routine testing for type 2 diabetes if you have certain risk
factors. You may have a higher risk of developing type 2 diabetes if you are

 age 35 or older
 American Indian, Black, or African American, Asian American,
Hispanic/Latino, or Pacific Islander
 Overweight or have obesity and have at least one other risk factor
 a woman who had gestational diabetes

Gestational diabetes

All pregnant women who do not have a previous diagnosis of diabetes should
be tested for gestational diabetes between 24 and 28 weeks of pregnancy.If
you have gestational diabetes, you should get tested after your baby is born to
see if you have type 2 diabetes, usually within 12 weeks after delivery.

What tests are used to diagnose diabetes?

Doctors use a variety of tests to diagnose diabetes and prediabetes. Your

doctor may recommend different tests depending on whether you have
symptoms or not, or whether you are pregnant.

Fasting plasma glucose test

The fasting plasma glucose (FPG) test measures your blood glucose level at a
single point in time. For the most reliable results, your doctor will give you the
test in the morning after you have fasted for at least 8 hours. Fasting means
having nothing to eat or drink except sips of water.

A1C test

The A1C test is a blood test that provides your average levels of blood glucose
over the last 3 months. Other names for the A1C test are haemoglobin A1C,
HbA1C, glycated haemoglobin, and glycosylated haemoglobin test. You can eat
and drink before this test. Before using the A1C test to diagnose diabetes, your
doctor will consider factors, such as whether you are in your second or third
trimester of pregnancy or whether you have certain types of anaemia NIH
external link or another problem with your blood.1 The A1C test might not be
accurate in those cases.
 Certain types of haemoglobin, called haemoglobin variants, can interfere with
measuring A1C levels. Most A1C tests used in the United States are not
affected by the most common variants. If your A1C test results and blood
glucose levels do not match, your doctor should consider that the A1C test may
not be a reliable test for you. Your doctor will report your A1C test result as a
percentage, such as an A1C of 7%. The higher the percentage is, the higher
your average blood glucose levels are.

Random plasma glucose test

Sometimes doctors use the random plasma glucose test to diagnose diabetes
when you have symptoms of diabetes and they do not want to wait until you
have fasted for 8 hours. You may have this blood test at any time.

Glucose challenge test

If you are pregnant, your doctor might test you for gestational diabetes with
the glucose challenge test. Another name for this test is the glucose screening
test. In this test, a health care professional will take a sample of your blood 1
hour after you drink a sweet liquid containing glucose. You do not need to fast
for this test. If your blood glucose level is too high—135 mg/dL to 140 mg/dL or
higher—you may need to return for an oral glucose tolerance test while
fasting.

Oral glucose tolerance test

The oral glucose tolerance test (OGTT) helps doctors detect type 2 diabetes,
prediabetes, and gestational diabetes. However, the OGTT is a more expensive
test than the FPG test and the glucose challenge test, and it is not as easy to
give. Before the test, you will need to fast for at least 8 hours. A health care
professional will take a blood sample to measure your glucose level after
fasting. Next, you will drink a liquid that is high in sugar. Another blood sample
is taken 2 hours later to check your blood glucose level. If your blood glucose
level is high, you may have diabetes.

If you are pregnant, your blood will be drawn every hour for 2 to 3 hours. If
your blood glucose levels are high two or more times during the OGTT, you
may have gestational diabetes.
 Genetic testing

Genetic testing can diagnose most forms of monogenic diabetes, which is

caused by a change—or mutation—in a gene. Anyone can have monogenic
diabetes, but it is more common in babies who develop diabetes before they
are 6 months old, some teens, and some young adults.

Autoantibodies

If you have diabetes, your doctor may look for certain autoantibodies to see if
your diabetes is type 1. Autoantibodies are proteins in your immune
system that mistakenly attack your healthy tissues and cells. A health care
professional will take a sample of your blood for this test. If autoantibodies for
diabetes are found in your blood, you may have type 1 diabetes.

Checking blood glucose levels

For many people with diabetes, checking their blood glucose level each day is
an important way to manage their diabetes. Monitoring your blood glucose
level is most important if you take insulin. The results of blood glucose
monitoring can help you make decisions about food, physical activity, and
medicines.

The most common way to check your blood glucose level at home is with
a blood glucose meter. You get a drop of blood by pricking the side of your
fingertip with a lancet. Then you apply the blood to a test strip. The meter will
show you how much glucose is in your blood now.

What are the recommended targets for blood glucose levels?

Many people with diabetes aim to keep their blood glucose at these normal
levels:

Before a meal: 80 to 130 mg/dL

About 2 hours after a meal starts: less than 180 mg/dL

Talk with your health care team about the best target range for you. Be sure to
tell your health care professional if your glucose levels often go above or below
your target range.
 What happens if my blood glucose level becomes too low?

Sometimes blood glucose levels drop below where they should be, which is
called hypoglycaemia. For most people with diabetes, the blood glucose level is
too low when it is below 70 mg/dL.

Hypoglycaemia can be life threatening and needs to be treated right away.

What happens if my blood glucose level becomes too high?

Doctors call high blood glucose hyperglycaemia.

Symptoms that your blood glucose levels may be too high include

feeling thirsty
feeling tired or weak
headaches
urinating often
blurred vision