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What is Diabetes?

Diabetes (also known as "Diabetes mellitus") refers to a group of chronic, lifelong metabolic diseases that cause the body difficulties processing glucose, or sugar, in the blood. Diabetes can be caused by decreased insulin production by pancreas and/or the organs abnormally reacting to insulin.

Vital cells require glucose for energy but risk damage when glucose sits in the blood rather than being transported to them by insulin. All types of diabetes are treatable with insulin, but are chronic conditions that require proper management to avoid complications.

Diabetes mellitus is the most common disorder of the endocrine system of the body, affecting more than 25 million people in the United States alone. It's estimated that 8% of the American population has some form of Diabetes, while an estimated additional 7 million people have Diabetes in the U.S. but have not yet received a diagnosis.

By definition, diabetes is having a blood glucose level of 126 mg/DL or higher after an overnight fast, or by having a non-fasting glucose level at or above 200 mg/dL, or a A1C greater than or equal to 6.5%.

With proper management and care from an endocrinologist, diabetes is a manageable, yet chronic illness. Let's explore diabetes a bit further.

How Is Diabetes Diagnosed?

Diabetes is diagnosed via a series of blood tests. Medical professionals recommend Diabetes screening for those who are 45 years of age and older, are overweight, have high blood pressure, have abnormal cholesterol levels, have been diagnosed with PCOS, or have a history of cardiovascular disease.

Doctors may recommend that a person under 45 be tested for diabetes if that individual is overweight, has a close relative (parent or sibling) that is diabetic, or has any of the above-mentioned risk factors for individuals over 45.

Classification of Diabetes:

There are four broad categories of diabetes: Type I, Type II, Gestational, and "Other Specific Types" (which include a few dozen types of rare forms of diabetes). Here is a breakdown of the most common types of diabetes, their symptoms and related treatments:

Pre-Diabetes:

Pre-Diabetes: In the US, nearly 80 million people over age 20 have higher-than-normal levels of blood glucose; but not high enough to be diagnosed as "diabetics." This condition is known as "pre-diabetes," or "impaired glucose tolerance." People who are pre-diabetic are generally asymptomatic, pre-diabetes is almost always present before a person develops Type 2 Diabetes.

It's important to note that complications that are associated with diabetes - like heart disease - may develop during this pre-diabetic period.

Once Type 2 diabetes develops, symptoms, such as unusual thirst, frequent urination, extreme fatigue, or blurred vision may or may not develop.

If pre-diabetes is suspected, it's important to reduce risk factors so that pre-diabetes does not develop into Type 2 Diabetes. Recommended steps to address pre-diabetes include weight loss (typically 5-10% of total body weight) and permanent changes in diet and exercise routines.

Type 1 Diabetes:

Type 1 Diabetes (chronic): Sometimes referred to as Juvenile Diabetes, Type I Diabetes often appears in during childhood. Type I Diabetes is type is the result of an autoimmune disorder that causes the immune system to attack the insulin-producing cells in the pancreas (called the beta cells), resulting in low insulin levels or no insulin whatsoever. Insulin injections are necessary in order for the body to process glucose.

There are no known ways to prevent Type 1 Diabetes. As it is an autoimmune disorder; comprising 10% of diabetes cases, most affected people (Type 1 Diabetes may develop in children or adults) are of normal size and weight.

What Causes Type 1 Diabetes?

Type 1 Diabetes is an autoimmune disease that can present in childhood, or at any age, often with other autoimmune diseases. While researchers are working to understand more about Type 1 Diabetes, it is not entirely clear what causes Type 1 Diabetes - there is both a genetic component, and likely environmental component.

Read more about Type 1 Diabetes.

Mechanism of Action for Type 1 Diabetes:

The hormone insulin is produced in small amounts by the pancreas in response to the sugars ingested in a meal. The amount of insulin that's released is proportional to the amount required by the meal.

Insulin works to move nutrients - including sugars - into the cells of the body's tissues, where they are used as a source of energy. The amount of sugar in the bloodstream decreases as it enters the cells.

That decrease in blood sugar, signals to the beta cells of the pancreas to decrease the amount of insulin being secreted, so that blood sugar levels do not drop too low, leading to hypoglycemia.

For those who have Type 1 Diabetes, the sugar is not moved into the cells as insulin is unavailable, which causes the levels of sugar in the blood to build up, in a condition called hyperglycemia. The cells of the body starve, necessitating other organ systems to step in and provide energy for the cells to function.

Hyperglycemia causes the following:

Dehydration: As sugars build up in the blood, the body begins to urinate more frequently in an attempt to rid the body of the excess sugars. The kidneys lose glucose and water, which leads to dehydration.

Weight Loss: During the excretion of sugar via the urine, the body loses the calories provided by the sugar.

DKA (Diabetic Ketoacidosis): The body begins to break down fat cells to provide energy to the starving cells. The fat cell breakdown releases a byproduct of acidic chemicals - ketones - that are used for energy. As the levels of ketones build up in the blood, the blood becomes more and more acidic. The liver, in an attempt to help the body, releases sugars. As the body cannot use sugars without insulin, levels of sugars in the blood continue to rise. The combination of high sugars, dehydration, plus acidic ketones is called "ketoacidosis" which is a life-threatening medical emergency.

Signs of DKA include:

Confusion
Shaking
Rapid respiratory rate
Fruit-smelling breath
Abdominal pain
Occasional loss of consciousness

Damage to Organ Systems - over time, the high levels of sugar in the blood can cause damage to a number or organ systems. The small blood vessels of the eyes, kidneys and heart can cause a predisposition to atherosclerosis, a condition that can lead to a myocardial infarction or a stroke (CVA).

What Are The Symptoms Of Type 1 Diabetes?

The symptoms of Type 1 Diabetes can range from very subtle to very severe and include the following:

Polyuria (frequent urination)
Polydipsia (increased thirst)
Polyphagia (increased hunger)
Dry mouth
Nausea and vomiting
Abdominal pain
Unexplained, unintentional weight loss
Fatigue
Blurred vision
Kussmaul respiration - a heavy, labored breathing
Infections of the skin, vagina, or urinary tract

How Is Type 1 Diabetes Diagnosed?

If there is a suspicion of Type 1 Diabetes, a simple finger-stick can test the levels of blood glucose. Also used for diagnosing Type 1 Diabetes is a urinalyses to check for glucose or ketones in the urine.

There are no screening tools available currently to ascertain the likelihood as to whether or not someone will develop Diabetes Type 1.

How Is Type 1 Diabetes Managed?

Most of the people who have Type 1 Diabetes go on to lead a long, healthy life. However living with Diabetes can be challenging: the key to maintaining good health includes blood sugars within the target range, by carefully managing meals, exercise and insulin therapy.

Insulin therapy is necessary for those who have Type 1 Diabetes. The individual must closely monitor blood glucose levels and take insulin supplements (usually injected using a syringe, although occasionally used via insulin pump). Because the pancreas makes little to no insulin to process glucose, diet and exercise alone will not be enough to treat Type 1 Diabetes.

Blood sugar levels must be routinely assessed and insulin, food, and activities must be adjusted to maintain normal blood sugars.

Complications of Type 1 Diabetes:

If Type 1 Diabetes isn't properly controlled, there are a number of serious complications that can occur. These include:

Diabetic Retinopathy: Diabetic Retinopathy is an eye problem that occurs in over 80% of adults who have diabetes, in which the blood vessels of the eye may swell and leak while abnormal blood vessels grow on the retina, causing vision loss.

Diabetic Nephropathy: a progressive kidney disease in which the nephrons of the kidneys become thickened and scarred over time, as the kidneys begin to leak and protein passes into the urine.

Diabetic Neuropathy: nerve damage caused by poor blood circulation related to diabetes. Symptoms can include pain, tingling, numbness, and problems in every organ system - including the GI tract.

Type 2 Diabetes:

Type 2 Diabetes (chronic): Type 2 Diabetes, the most common form of Diabetes Mellitus, is a metabolic disorder characterized by improper insulin usage. For someone with Type 2 Diabetes, their body does not produce enough insulin or may respond incorrectly to insulin (insulin-resistance), preventing the normal processing of glucose.

Mechanism of Action for Type 2 Diabetes:

Our bodies are made of millions of cells, which each require energy, which is provided by the breakdown of glucose from our food. The glucose is transported through the bloodstream where it enters the cells of the body to provide the body with enough energy to function.

The amount of blood glucose is regulated by hormones, including insulin, which is continually released by the pancreas in response to the levels of glucose in the bloods. To ensure the sugar in the blood stays consistent, the body signals the release of glucose stores in the liver and informs the pancreas to lower the amount of insulin that's released.

Those who have Type 2 Diabetes do not produce enough insulin or are unable to recognize insulin, which creates high blood sugars.

Risk Factors For Type 2 Diabetes:

Type 2 Diabetes is believed to have a substantial genetic component - as it tends to run in families. Managing the risk factors for Type 2 Diabetes can make managing diabetes much easier.

Type 2 Diabetes is more likely to occur in individuals who have a poor diet and lack of exercise because the pancreas cannot produce enough insulin to support food intake. The disease is typically slow developing and it's possible to show no symptoms.

The risk factors may include:

Hypertension
High levels of blood triglyceride levels
History of gestational diabetes
High-fat diet
High alcohol intake
A mostly sedentary lifestyle
Has had prediabetes
Obesity
Ethinc groups - African Americans, Native Americans, Hispanic Americans, and Japanese Americans have a greater risk for developing Type 2 Diabetes.
Age over 45

What Are The Symptoms Of Type 2 Diabetes?

Most of the time, those who have Type 2 Diabetes will be asymptomatic. When people who have Type 2 Diabetes display symptoms, these symptoms may vary from individual to individual and may include:

Polyuria (frequent urination)
Polydipsia (increased thirst)
Polyphagia (increased hunger)
Dry mouth
Nausea and vomiting
Fatigue
Blurred vision
Infections of the skin, vagina or urinary tract
Numbness and tingling of the hands or feet.
Slowly healing wounds.

How Is Type 2 Diabetes Diagnosed?

Type 2 Diabetes may be diagnosed by examining the blood for high levels of blood glucose during a fasting test or a screening test called the "2 Hour Glucose Tolerance Fast." Another diagnostic test is the Hemoglobin A1C, which reflects the average of blood sugars over a period of several days.

How Is Type 2 Diabetes Treated?

Treatment for Type 2 Diabetes includes one or more of the following treatment methods:

Weight loss and exercise, which promote sensitivity to insulin
Regular dietary changes to control levels of blood glucose
Medication to control glucose levels or increase sensitivity to insulin - oral, injectable, pump, or inhalable
Pancreatic transplant (sometimes combined with kidney transplant)

What Are The Complications of Type 2 Diabetes?

If Type 2 Diabetes isn't properly controlled, there are a number of serious complications that can occur. These include:

Diabetic Nephropathy: a progressive kidney disease in which the nephrons of the kidneys become thickened and scarred over time, as the kidneys begin to leak and protein passes into the urine.

Diabetic Neuropathy: nerve damage caused by poor blood circulation related to diabetes. Symptoms can include pain, tingling, numbness, and problems in every organ system - including the GI tract.

Gestational Diabetes:

Gestational Diabetes: This refers to diabetes - or high blood sugar levels - that occur only during pregnancy, which typically resolves post-birth. GD occurs in about 4% of all pregnancies.

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