Diabetes mellitus is a metabolic disorder that occurs when the body either doesn’t produce sufficient insulin or doesn’t use insulin properly causing blood sugar (glucose) levels to rise (hyperglycemia). Glucose is the body’s main source of energy, and the pancreas produces a hormone called insulin that helps convert glucose from the food you eat into energy your body uses.
There are 3 main types of diabetes:
- Type 1 diabetes (previously called insulin-dependent or juvenile diabetes) is a condition in which little to no insulin is produced by the pancreas. It is an autoimmune condition, which means it is chronic and will need to be managed for the rest of your life.
- There is no way to get rid of type 1 diabetes permanently. It is an autoimmune condition, which means it is chronic and will need to be managed for the rest of your life.
- Type 2 diabetes occurs when the body doesn’t use insulin properly causing blood sugar levels to rise. It is the most common form of diabetes.
- Gestational diabetes is a condition that disrupts the way the body uses sugar (glucose) during pregnancy. It occurs because pregnancy increases the body's need for insulin, but the body cannot always make enough.
- After delivery, gestational diabetes usually goes away and a woman’s blood sugar levels will return to normal. Women with gestational diabetes do have an increased risk of developing type 2 diabetes later in life, and up to two-thirds of women who have gestational diabetes in one pregnancy will have it again in a subsequent pregnancy so maintaining a healthy diet is important.
What Are Symptoms of Diabetes?
Symptoms of diabetes include:
- Increased urination
- Increased thirst
- Increased hunger, even though people are eating
- Blurred vision
- Sores/cuts/bruises that do not heal
- Frequent infections
- Darkened skin, often in the armpits and neck
- Numbness, tingling, or pain in the feet or hands (more common in type 2)
- Unexplained weight loss (more common in type 1)
What Causes Diabetes?
Type 1 diabetes is believed to be caused by an autoimmune reaction in which the body attacks itself and destroys beta cells in the pancreas that make insulin.
Risk factors for developing type 1 diabetes include:
- Triggers, such as viruses
Type 1 diabetes is not caused by diet or lifestyle factors.
Type 2 diabetes is caused by several factors, including:
- Family history
- Tends to occur more in certain ethnic groups: African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander
- Lifestyle factors
- Being overweight or obese
- Physical inactivity
Factors that can increase the risk of developing type 2 diabetes include:
- Age 45 or older
- Low HDL (“good”) cholesterol or high triglycerides
- High blood pressure
- A history of heart disease or stroke
- A history of gestational diabetes
- Giving birth to a baby weighing 9 pounds or more
- Polycystic ovary syndrome (PCOS)
It is unknown what causes gestational diabetes and it can be difficult to predict which women will develop the condition when they are pregnant.
Risk factors for developing gestational diabetes include:
- Prior gestational diabetes during pregnancy
- Family history of diabetes
- Being overweight/obese
- Age older than 25
- Ethnicity: Hispanic-American, African-American, Native American, South or East Asian, or Pacific Islander
How Is Diabetes Diagnosed?
Diabetes is diagnosed with the following tests:
- Fasting plasma glucose (FPG) test
- A1C test
- Glucose challenge test
- Random plasma glucose (RPG) test
- Oral glucose tolerance test (OGTT)
What Is the Treatment for Diabetes?
Diabetes is treated with lifestyle modifications and medications when needed.
Lifestyle changes to manage diabetes include:
- Manage A1C (average blood glucose level over the past 3 months)
- Check blood glucose levels daily
- Keep blood pressure in check
- Maintain healthy cholesterol levels
- Don’t smoke
- Follow a diabetes meal plan as recommended by your doctor or nutritionist
- Eat plenty of fruits and vegetables, whole grains, beans, lean poultry and fish, and low-fat dairy
- Drink plenty of water
- Choose foods that are low-calorie, low-fat, low-sugar, and low-salt
- Exercise regularly
- Get adequate sleep
- Manage stress/practice relaxation techniques
- Take prescribed diabetes medications
Medications used to treat diabetes include:
- People who have type 1 diabetes need to take insulin shots or wear an insulin pump every day to manage blood sugar levels
- About 15% of women with gestational diabetes will require insulin
- Meglitinides such as repaglinide (Prandin) and nateglinide (Starlix)
- Alpha-glucosidase inhibitors such as miglitol (Glyset) and acarbose (Precose)
- Thiazolidinediones such as pioglitazone (Actos) and rosiglitazone (Avandia)
- DPP- 4 Inhibitors such as sitagliptin (Januvia), saxagliptin (Onglyza), alogliptin (Nesina), and linagliptin (Tradjenta)
- Sulfonylureas such as glimepiride (Amaryl), glyburide (Diabeta, Glynase), chlorpropamide (Diabinese), glipizide (Glucotrol, Glucotrol XL), tolbutamide, and tolazamide
- Biguanides such as metformin (Fortamet, Glucophage, Glucophage XR, Glumetza, and Riomet)
- Dopamine receptor agonists such as bromocriptine (cycloset)
- Bile acid sequestrants such as colesevelam (Welchol)
- SGLT2 inhibitors such as dapagliflozin (Farxiga), canagliflozin (Invokana), empagliflozin (Jardiance), and ertugliflozin (Steglatro)
- GLP-1 receptor agonists such as lixisenatide (Adlyxin), exenatide (Bydureon, Byetta), semaglutide (Ozempic), albiglutide (Tanzeum), dulaglutide (Trulicity), and liraglutide (Victoza)
- Amylin analog such as pramlintide acetate (Symlin)
- Combination medicines, which may be made up of more than one medication in the above classes
- People with gestational diabetes may need insulin or metformin
If lifestyle changes and medications are insufficient, other treatments for diabetes may include:
- Weight-loss surgery (bariatric surgery) for certain patients who are obese
- Artificial pancreas
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