Diabetes
A chronic metabolic disorder characterized by elevated blood glucose levels
Quick Facts
- Type: Metabolic Disorder
- ICD-10: E10-E14
- Prevalence: ~10% of adults
- Onset: Any age
Overview
Diabetes mellitus, commonly referred to as diabetes, is a group of metabolic disorders characterized by persistently high blood sugar levels. This chronic condition occurs when the pancreas doesn't produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood glucose, allowing cells to use sugar for energy.
There are several types of diabetes, with Type 1 and Type 2 being the most common. Type 1 diabetes is an autoimmune condition where the immune system attacks insulin-producing cells in the pancreas. Type 2 diabetes, which accounts for about 90% of all diabetes cases, occurs when the body becomes resistant to insulin or doesn't produce enough insulin. Gestational diabetes develops during pregnancy and usually resolves after delivery, though it increases the risk of developing Type 2 diabetes later in life.
Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke, and lower limb amputation. However, with proper management including blood sugar monitoring, medication, lifestyle modifications, and regular medical care, people with diabetes can live long, healthy lives and prevent or delay complications.
Symptoms
The symptoms of diabetes can vary depending on how elevated your blood sugar is. Some people, especially those with prediabetes or Type 2 diabetes, may not experience symptoms initially. In Type 1 diabetes, symptoms tend to come on quickly and be more severe.
Common Symptoms
Additional Symptoms
- Increased hunger (polyphagia)
- Blurred vision
- Slow-healing sores or frequent infections
- Areas of darkened skin (acanthosis nigricans)
- Irritability or mood changes
- Presence of ketones in urine (Type 1)
Symptoms of Complications
Long-term diabetes complications can lead to additional symptoms:
- Numbness or tingling in hands or feet (neuropathy)
- Vision problems (retinopathy)
- Leg pain when walking (peripheral arterial disease)
- Erectile dysfunction in men
- Recurring skin, gum, or bladder infections
Causes
The causes of diabetes vary by type, but all forms involve problems with insulin production or function:
Type 1 Diabetes
Type 1 diabetes is caused by an autoimmune reaction where the body's immune system attacks and destroys the insulin-producing beta cells in the pancreas. The exact trigger for this autoimmune response is unknown, but genetic and environmental factors play a role. Possible triggers include:
- Viral infections
- Environmental toxins
- Genetic predisposition
- Geography (more common in certain regions)
Type 2 Diabetes
Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas stops producing enough insulin. Contributing factors include:
- Excess body weight, especially abdominal obesity
- Physical inactivity
- Poor diet high in processed foods and sugar
- Genetic factors and family history
- Age (risk increases after 45)
- Certain ethnic backgrounds
- Metabolic syndrome
Gestational Diabetes
During pregnancy, the placenta produces hormones that can lead to insulin resistance. If the pancreas can't produce enough insulin to overcome this resistance, gestational diabetes develops.
Risk Factors
Several factors increase the risk of developing diabetes:
Type 1 Diabetes Risk Factors
- Family history (parent or sibling with Type 1 diabetes)
- Age (peaks at ages 4-7 and 10-14)
- Geography (higher rates in Finland and Sardinia)
- Certain genetic markers
Type 2 Diabetes Risk Factors
- Being overweight or obese
- Age 45 or older
- Family history of Type 2 diabetes
- Physical inactivity
- Race/ethnicity (higher risk in African Americans, Hispanic/Latino Americans, Native Americans, Asian Americans)
- Prediabetes
- History of gestational diabetes
- High blood pressure
- Abnormal cholesterol levels
- Polycystic ovary syndrome (PCOS)
Diagnosis
Diabetes is diagnosed through blood tests that measure blood glucose levels. The American Diabetes Association recommends the following diagnostic criteria:
Diagnostic Tests
- Fasting Plasma Glucose (FPG): ≥126 mg/dL after no caloric intake for at least 8 hours
- Oral Glucose Tolerance Test (OGTT): ≥200 mg/dL 2 hours after drinking a glucose solution
- Hemoglobin A1C: ≥6.5% (reflects average blood sugar over 2-3 months)
- Random Plasma Glucose: ≥200 mg/dL with classic symptoms of hyperglycemia
Additional Tests
Once diagnosed, additional tests may be performed:
- C-peptide test (to distinguish Type 1 from Type 2)
- Autoantibody tests (for Type 1 diabetes)
- Ketone testing
- Lipid profile
- Kidney function tests
- Eye examination
- Foot examination
Treatment Options
Diabetes management requires a comprehensive approach involving blood sugar monitoring, medications, lifestyle changes, and regular medical care. Treatment plans are individualized based on the type of diabetes, overall health, and personal circumstances.
Blood Sugar Monitoring
Regular monitoring helps track glucose levels and adjust treatment:
- Self-monitoring with glucose meters
- Continuous glucose monitoring (CGM) systems
- Regular A1C tests every 3-6 months
Medications
Type 1 Diabetes:
- Insulin therapy (required for all Type 1 patients)
- Rapid-acting, short-acting, intermediate-acting, or long-acting insulin
- Insulin pumps or multiple daily injections
Type 2 Diabetes:
- Metformin (usually first-line medication)
- Sulfonylureas
- DPP-4 inhibitors
- GLP-1 receptor agonists
- SGLT2 inhibitors
- Insulin (if other medications aren't sufficient)
Lifestyle Management
- Diet: Balanced meals with controlled carbohydrates, high fiber, lean proteins
- Exercise: At least 150 minutes of moderate aerobic activity weekly
- Weight management: Achieving and maintaining a healthy weight
- Stress management: Techniques to reduce stress impact on blood sugar
- Sleep: Adequate quality sleep (7-9 hours)
Prevention
While Type 1 diabetes cannot currently be prevented, Type 2 diabetes can often be prevented or delayed through lifestyle modifications:
Primary Prevention Strategies
- Maintain healthy weight: Even a 5-7% weight loss can significantly reduce risk
- Regular physical activity: 30 minutes of moderate exercise most days
- Healthy diet: Emphasize whole grains, fruits, vegetables, lean proteins
- Limit processed foods: Reduce sugar-sweetened beverages and refined carbohydrates
- Don't smoke: Smoking increases diabetes risk by 30-40%
- Moderate alcohol consumption: If you drink, do so in moderation
For High-Risk Individuals
People with prediabetes or other risk factors may benefit from:
- Diabetes prevention programs
- Regular screening
- Medication (metformin) in some cases
- More intensive lifestyle interventions
When to See a Doctor
Seek medical attention if you experience:
Immediate Medical Attention
- Symptoms of diabetic ketoacidosis: fruity breath, nausea, vomiting, abdominal pain
- Severe hypoglycemia (low blood sugar) with confusion or loss of consciousness
- Signs of infection that won't heal
- Chest pain or difficulty breathing
- Sudden vision changes
Schedule an Appointment
- Classic diabetes symptoms (excessive thirst, frequent urination, fatigue)
- Risk factors for diabetes and want screening
- Diagnosed with prediabetes
- Family planning (for women with diabetes)
- Difficulty managing blood sugar levels
- New or worsening complications
Frequently Asked Questions
Currently, there is no cure for diabetes. However, Type 2 diabetes can go into remission with significant lifestyle changes and weight loss. Type 1 diabetes requires lifelong insulin therapy, but research into potential cures, including beta cell transplants and immunotherapy, is ongoing.
Both Type 1 and Type 2 diabetes have genetic components. Having a family member with diabetes increases your risk, but genetics alone don't determine if you'll develop diabetes. Environmental factors and lifestyle choices play significant roles, especially in Type 2 diabetes.
Yes, with proper management, people with diabetes can live long, healthy, and active lives. This includes maintaining good blood sugar control, taking medications as prescribed, following a healthy lifestyle, and getting regular medical care to prevent complications.
Focus on limiting foods high in refined sugars, processed carbohydrates, saturated fats, and sodium. This includes sugary drinks, candy, white bread, fried foods, and high-fat dairy products. Work with a dietitian to create a personalized meal plan.
The frequency depends on your type of diabetes and treatment plan. People with Type 1 diabetes typically check 4-10 times daily. Those with Type 2 diabetes may check less frequently, depending on their medications. Your healthcare provider will recommend a monitoring schedule.
References
- American Diabetes Association. Standards of Medical Care in Diabetes—2024. Diabetes Care. 2024.
- World Health Organization. Diabetes Fact Sheet. WHO. 2023.
- Centers for Disease Control and Prevention. National Diabetes Statistics Report. CDC. 2023.
- International Diabetes Federation. IDF Diabetes Atlas. 10th edition. 2023.
- National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes Overview. NIDDK. 2023.