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Diabetes Mellitus
Diabetes Mellitus
If you have diabetes, your body isn’t able to properly process and use glucose from the
food you eat. There are different types of diabetes, each with different causes, but they
all share the common problem of having too much glucose in your bloodstream.
Treatments include medications and/or insulin. Some types of diabetes can be
prevented by adopting a healthy lifestyle.
OVERVIEW
What is diabetes?
Diabetes happens when your body isn't able to take up sugar (glucose) into its cells and
use it for energy. This results in a build-up of extra sugar in your bloodstream.
The process of digestion includes breaking down the food you eat into various different
nutrient sources. When you eat carbohydrates (for example, bread, rice, pasta), your
body breaks this down into sugar (glucose). When glucose is in your bloodstream, it
needs help – a "key" – to get into its final destination where it's used, which is inside
your body's cells (cells make up your body's tissues and organs). This help or "key" is
insulin.
Insulin is a hormone made by your pancreas, an organ located behind your stomach.
Your pancreas releases insulin into your bloodstream. Insulin acts as the “key” that
unlocks the cell wall “door,” which allows glucose to enter your body’s cells. Glucose
provides the “fuel” or energy tissues and organs need to properly function.
Or
Your pancreas makes insulin but your body’s cells don’t respond to it and can’t
use it as it normally should.
If glucose can’t get into your body’s cells, it stays in your bloodstream and your blood
glucose level rises.
Diabetes insipidus is a distinct rare condition that causes your kidneys to produce a
large amount of urine.
Some 34.2 million people of all ages – about 1 in 10 – have diabetes in the U.S. Some
7.3 million adults aged 18 and older (about 1 in 5) are unaware that they have diabetes
(just under 3% of all U.S. adults). The number of people who are diagnosed with
diabetes increases with age. More than 26% of adults age 65 and older (about 1 in 4)
have diabetes.
Factors that increase your risk differ depending on the type of diabetes you ultimately
develop.
The cause of diabetes, regardless of the type, is having too much glucose circulating in
your bloodstream. However, the reason why your blood glucose levels are high differs
depending on the type of diabetes.
Increased thirst.
Weak, tired feeling.
Blurred vision.
Numbness or tingling in the hands or feet.
Slow-healing sores or cuts.
Unplanned weight loss.
Frequent urination.
Frequent unexplained infections.
Dry mouth.
Other symptoms
Type 2 diabetes and pre-diabetes symptoms: You may not have any symptoms at all
or may not notice them since they develop slowly over several years. Symptoms usually
begin to develop when you’re an adult, but pre-diabetes and Type 2 diabetes is on the
rise in all age groups.
Gestational diabetes: You typically will not notice symptoms. Your obstetrician will test
you for gestational diabetes between 24 and 28 weeks of your pregnancy.
If your blood glucose level remains high over a long period of time, your body’s tissues
and organs can be seriously damaged. Some complications can be life-threatening over
time.
Complications include:
Diabetes is diagnosed and managed by checking your glucose level in a blood test.
There are three tests that can measure your blood glucose level: fasting glucose test,
random glucose test and A1c test.
Fasting plasma glucose test: This test is best done in the morning after an
eight hour fast (nothing to eat or drink except sips of water).
Random plasma glucose test: This test can be done any time without the need
to fast.
A1c test: This test, also called HbA1C or glycated hemoglobin test, provides
your average blood glucose level over the past two to three months. This test
measures the amount of glucose attached to hemoglobin, the protein in your red
blood cells that carries oxygen. You don’t need to fast before this test.
Oral glucose tolerance test: In this test, blood glucose level is first measured
after an overnight fast. Then you drink a sugary drink. Your blood glucose level is
then checked at hours one, two and three.
Fasting
Less than 100 100-125 126 or higher
glucose test
Random (anytime)
Less than 140 140-199 200 or higher
glucose test
A1c test Less than 5.7% 5.7 - 6.4% 6.5% or higher
Oral glucose
Less than 140 140-199 200 or higher
tolerance test
Gestational diabetes tests: There are two blood glucose tests if you are pregnant.
With a glucose challenge test, you drink a sugary liquid and your glucose level is
checked one hour later. You don’t need to fast before this test. If this test shows a
higher than normal level of glucose (over 140 ml/dL), an oral glucose tolerance
test will follow (as described above).
Type 1 diabetes: If your healthcare provider suspects Type 1 diabetes, blood and urine
samples will be collected and tested. The blood is checked for autoantibodies (an
autoimmune sign that your body is attacking itself). The urine is checked for the
presence of ketones (a sign your body is burning fat as its energy supply). These signs
indicate Type 1 diabetes.
If you have symptoms or risk factors for diabetes, you should get tested. The earlier
diabetes is found, the earlier management can begin and complications can be
lessened or prevented. If a blood test determines you have pre-diabetes, you and your
healthcare professional can work together to make lifestyle changes (e.g. weight loss,
exercise, healthy diet) to prevent or delay developing Type 2 diabetes.
Testing for Type 1 diabetes: Test in children and young adults who have a
family history of diabetes. Less commonly, older adults may also develop Type 1
diabetes. Therefore, testing in adults who come to the hospital and are found to
be in diabetes-related ketoacidosis is important. Ketoacidosis a dangerous
complication that can occur in people with Type 1 diabetes.
Testing for type 2 diabetes: Test adults age 45 or older, those between 19 and
44 who have overweight/obesity and have one or more risk factors, women who
have had gestational diabetes, children between 10 and 18 who
overweight/obesity and have at least two risk factors for type 2 diabetes.
Gestational diabetes: Test all pregnant women who have had a diagnosis of
diabetes. Test all pregnant women between weeks 24 and 28 of their pregnancy.
If you have other risk factors for gestational diabetes, your obstetrician may test
you earlier.
Diabetes affects your whole body. To best manage diabetes, you’ll need to take steps to
manage your risk factors, including:
Keep your blood glucose levels as near to normal as possible by following a diet
plan, taking prescribed medication and increasing your activity level.
Maintain your blood cholesterol (HDL and LDL levels) and triglyceride levels as
near the normal ranges as possible.
Manage your blood pressure. Your blood pressure should not be over 140/90
mmHg.
Planning what you eat and following a healthy meal plan. Follow a Mediterranean
diet (vegetables, whole grains, beans, fruits, healthy fats, low sugar)
or Dash diet. These diets are high in nutrition and fiber and low in fats and
calories. See a registered dietician for help understanding nutrition and meal
planning.
Exercising regularly. Try to exercise at least 30 minutes most days of the week.
Walk, swim or find some activity you enjoy.
Achieving a healthy weight. Work with your healthcare team to develop a weight-
loss plan.
Taking medication and insulin, if prescribed, and closely following
recommendations on how and when to take it.
Monitoring your blood glucose and blood pressure levels at home.
Keeping your appointments with your healthcare providers and having laboratory
tests completed as ordered by your doctor.
Quitting smoking (if you smoke).
Checking your blood glucose level is important because the results help guide decisions
about what to eat, your physical activity and any needed medication and insulin
adjustments or additions.
The most common way to check your blood glucose level is with a blood glucose meter.
With this test, you prick the side of your finger, apply the drop of blood to a test strip,
insert the strip into the meter and the meter will show your glucose level at that moment
in time. Your healthcare provider will tell you how often you’ll need to check your
glucose level.
Ask your healthcare team what your blood glucose level should be. They may have a
specific target range for you. In general, though, most people try to keep their blood
glucose levels at these targets:
Having a blood glucose level that is lower than the normal range (usually below 70
mg/dL) is called hypoglycemia. This is a sign that your body gives out that you need
sugar.
Weakness or shaking.
Moist skin, sweating.
Fast heartbeat.
Dizziness.
Sudden hunger.
Confusion.
Pale skin.
Numbness in mouth or tongue.
Irritability, nervousness.
Unsteadiness.
Nightmares, bad dreams, restless sleep.
Blurred vision.
Headaches, seizures.
If you have too much glucose in your blood, you have a condition called hyperglycemia.
Hyperglycemia is defined as:
A blood glucose level greater than 125 mg/dL while in the fasting state (nothing
to eat or drink for at least eight hours).
or
A blood glucose level greater than 180 mg/dL one to two hours after eating.
Treatments for diabetes depend on your type of diabetes, how well managed your blood
glucose level is and your other existing health conditions.
Type 1 diabetes: If you have this type, you must take insulin every day. Your
pancreas no longer makes insulin.
Type 2 diabetes: If you have this type, your treatments can include medications
(both for diabetes and for conditions that are risk factors for diabetes), insulin and
lifestyle changes such as losing weight, making healthy food choices and being
more physically active.
Pre-diabetes: If you have pre-diabetes, the goal is to keep you from progressing
to diabetes. Treatments are focused on treatable risk factors, such as losing
weight by eating a healthy diet (like the Mediterranean diet) and exercising (at
least five days a week for 30 minutes). Many of the strategies used to prevent
diabetes are the same as those recommended to treat diabetes (see prevention
section of this article).
Gestational diabetes: If you have this type and your glucose level is not too
high, your initial treatment might be modifying your diet and getting regular
exercise. If the target goal is still not met or your glucose level is very high, your
healthcare team may start medication or insulin.
Oral medications and insulin work in one of these ways to treat your diabetes:
Over 40 medications have been approved by the Food and Drug Administration for the
treatment of diabetes. It’s beyond the scope of this article to review all of these drugs.
Instead, we’ll briefly review the main drug classes available, how they work and present
the names of a few drugs in each class. Your healthcare team will decide if medication
is right for you. If so, they’ll decide which specific drug(s) are best to treat your diabetes.
Many oral diabetes medications may be used in combination or with insulin to achieve
the best blood glucose management. Some of the above medications are available as a
combination of two medicines in a single pill. Others are available as injectable
medications, for example, the GLP-1 agonist semaglutide (Ozempic®) and lixisenatide
(Adlyxin®).
Always take your medicine exactly as your healthcare prescribes it. Discuss your
specific questions and concerns with them.
There are many types of insulins for diabetes. If you need insulin, you healthcare team
will discuss the different types and if they are to be combined with oral medications. To
follow is a brief review of insulin types.
There are insulins that are a combination of different insulins. There are also insulins
that are combined with a GLP-1 receptor agonist medication (e.g. Xultophy®,
Soliqua®).
How is insulin taken? How many different ways are there to take insulin?
Insulin is available in several different formats. You and your healthcare provider will
decide which delivery method is right for you based on your preference, lifestyle, insulin
needs and insurance plan. Here’s a quick review of available types.
Needle and syringe: With this method, you’ll insert a needle into a vial of insulin,
pull back the syringe and fill the needle with the proper dose of insulin. You’ll
inject the insulin into your belly or thigh, buttocks or upper arm – rotating the
injection spots. You may need to give yourself one or more shots a day to
maintain your target blood glucose level.
Insulin pen: This device looks like a pen with a cap. They come prefilled with
insulin or with insulin cartridges that are inserted and replaced after use.
Insulin pump: Insulin pumps are small, computerized devices, about the size of
a small cell phone that you wear on your belt, in your pocket, or under your
clothes. They deliver rapid-acting insulin 24 hours a day through a small flexible
tube called a cannula. The cannula is inserted under the skin using a needle. The
needle is then removed leaving only the flexible tube under the skin. You
replaces the cannula every two to three days. Another type of insulin pump is
attached directly to your skin and does not use tubes.
Artificial pancreas (also called a closed loop insulin delivery system): This
system uses an insulin pump linked to a continuous glucose monitor. The
monitor checks your blood glucose levels every five minutes and then the pump
delivers the needed dose of insulin.
Insulin inhaler: Inhalers allow you to breath in powdered inhaler through an
inhaler device that you insert into your mouth. The insulin is inhaled into your
lungs, then absorbed into your bloodstream. Inhalers are only approved for use
by adults with Type 1 or Type 2 diabetes.
Insulin injection port: This delivery method involves the placement of a short
tube into tissue beneath your skin. The port is held in place with an adhesive
patch. You use a needle and syringe or insulin pen and inject the insulin through
this port. The port is changed every few days. The port provides a single site for
injection instead of having to rotate injection sites.
Jet injector: This is a needleless delivery method that uses high pressure to
send a fine spray of insulin through your skin.
Yes. There are two types of transplantations that might be an option for a select number
of patients who have Type 1 diabetes. A pancreas transplant is possible. However,
getting an organ transplant requires taking immune-suppressing drugs for the rest of
your life and dealing with the side effects of these drugs. However, if the transplant is
successful, you’ll likely be able to stop taking insulin.
Another treatment under research for Type 1 diabetes is immunotherapy. Since Type 1
is an immune system disease, immunotherapy holds promise as a way to use
medication to turn off the parts of the immune system that cause Type 1 disease.
Bariatric surgery is another treatment option that’s an indirect treatment for diabetes.
Bariatric surgery is an option if you have Type 2 diabetes, have obesity (body mass
index over 35) and considered a good candidate for this type of surgery. Much improved
blood glucose levels are seen in people who have lost a significant amount of weight.
Of course other medications are prescribed to treat any existing health problems that
contribute to increasing your risk of developing diabetes. These conditions include high
blood pressure, high cholesterol and other heart-related diseases.
PREVENTION
Can prediabetes, Type 2 diabetes and gestational diabetes be prevented?
Although diabetes risk factors like family history and race can’t be changed, there are
other risk factors that you do have some control over. Adopting some of the healthy
lifestyle habits listed below can improve these modifiable risk factors and help to
decrease your chances of getting diabetes:
Eat a healthy diet, such as the Mediterranean or Dash diet. Keep a food diary
and calorie count of everything you eat. Cutting 250 calories per day can help
you lose ½ pound per week.
Get physically active. Aim for 30 minutes a day at least five days a week. Start
slow and work up to this amount or break up these minutes into more doable 10-
minute segments. Walking is great exercise.
Work to achieve a weight that's healthy for you. Don’t lose weight if you are
pregnant, but check with your obstetrician about healthy weight gain during your
pregnancy.
Lower your stress. Learn relaxation techniques, deep breathing exercises,
mindful meditation, yoga and other helpful strategies.
Limit alcohol intake. Men should drink no more than two beverages containing
alcohol a day; women should drink no more than one.
Get an adequate amount of sleep (typically 7 to 9 hours).
Quit smoking.
Take medications as directed by your healthcare provider to manage
existing risk factors for heart disease (like high blood pressure, cholesterol) or to
reduce the risk of developing Type 2 diabetes.
If you think you have symptoms of prediabetes, see your provider.
No. Type 1 diabetes is an autoimmune disease, meaning your body attacks itself.
Scientists aren’t sure why someone’s body would attack itself. Other factors may be
involved too, such as genetic changes.
Chronic complications are responsible for most illness and death associated with
diabetes. Chronic complications usually appear after several years of elevated blood
sugars (hyperglycemia). Since patients with Type 2 diabetes may have elevated blood
sugars for several years before being diagnosed, these patients may have signs of
complications at the time of diagnosis.
The complications of diabetes have been described earlier in this article. Although the
complications can be wide ranging and affect many organ systems, there are many
basic principles of prevention that are shared in common. These include:
OUTLOOK / PROGNOSIS
What should I expect if I have been diagnosed with diabetes?
If you have diabetes, the most important thing you can do is keep your blood glucose
level within the target range recommended by your healthcare provider. In general,
these targets are:
You will need to closely follow a treatment plan, which will likely include following a
customized diet plan, exercising 30 minutes five times a week, quitting smoking, limiting
alcohol and getting seven to nine hours of sleep a night. Always take your medications
and insulin as instructed by your provider.
LIVING WITH
When should I call my doctor?
If you haven’t been diagnosed with diabetes, you should see your healthcare provider if
you have any symptoms of diabetes. If you already have been diagnosed with diabetes,
you should contact your provider if your blood glucose levels are outside of your target
range, if current symptoms worsen or if you develop any new symptoms.
Sugar itself doesn't directly cause diabetes. Eating foods high in sugar content can lead
to weight gain, which is a risk factor for developing diabetes. Eating more sugar than
recommended — American Heart Association recommends no more than six teaspoons
a day (25 grams) for women and nine teaspoons (36 grams) for men — leads to all
kinds of health harms in addition to weight gain.
These health harms are all risk factors for the development of diabetes or can worsen
complications. Weight gain can:
Most people with diabetes see their primary healthcare provider first. Your provider
might refer you to an endocrinologist/pediatric endocrinologist, a physician who
specializes in diabetes care. Other members of your healthcare team may include an
ophthalmologist (eye doctor), nephrologist (kidney doctor), cardiologist (heart doctor),
podiatrist (foot doctor), neurologist (nerve and brain doctor), gastroenterologist
(digestive tract doctor), registered dietician, nurse practitioners/physician assistants,
diabetes educator, pharmacist, personal trainer, social worker, mental health
professional, transplant team and others.
In general, if you are being treated with insulin shots, you should see your doctor at
least every three to four months. If you are treated with pills or are managing diabetes
through diet, you should be seen at least every four to six months. More frequent visits
may be needed if your blood sugar isn't managed or if complications of diabetes are
worsening.
Can diabetes be cured or reversed?
Although these seem like simple questions, the answers are not so simple. Depending
on the type of your diabetes and its specific cause, it may or may not be possible to
reverse your diabetes. Successfully reversing diabetes is more commonly called
achieving “remission.”
Type 1 diabetes is an immune system disease with some genetic component. This
type of diabetes can’t be reversed with traditional treatments. You need lifelong insulin
to survive. Providing insulin through an artificial pancreas (insulin pump plus continuous
glucose monitor and computer program) is the most advanced way of keeping glucose
within a tight range at all times – most closely mimicking the body. The closest thing
toward a cure for Type 1 is a pancreas transplant or a pancreas islet transplant.
Transplant candidates must meet strict criteria to be eligible. It’s not an option for
everyone and it requires taking immunosuppressant medications for life and dealing
with the side effects of these drugs.
If you have gestational diabetes, this type of diabetes ends with the birth of your child.
However, having gestational diabetes is a risk factor for developing Type 2 diabetes.
The good news is that diabetes can be effectively managed. The extent to which your
Type 1 or Type 2 diabetes can be managed is a discussion to have with your healthcare
provider.
Yes, it’s possible that if diabetes remains undiagnosed and unmanaged (severely high
or severely low glucose levels) it can cause devastating harm to your body. Diabetes
can cause heart attack, heart failure, stroke, kidney failure and coma. These
complications can lead to your death. Cardiovascular disease in particular is the leading
cause of death in adults with diabetes.
Although having diabetes may not necessarily increase your risk of contracting COVID-
19, if you do get the virus, you are more likely to have more severe complications. If you
contract COVID-19, your blood sugars are likely to increase as your body is working to
clear the infection. If you contract COVID-19, contact your healthcare team early to let
them know.
How does diabetes affect your heart, eyes, feet, nerves and kidneys?
Blood vessels are located throughout our body’s tissues and organs. They surround our
body’s cells, providing a transfer of oxygen, nutrients and other substances, using blood
as the exchange vehicle. In simple terms, diabetes doesn’t allow glucose (the body’s
fuel) to get into cells and it damages blood vessels in/near these organs and those that
nourish nerves. If organs, nerves and tissues can’t get the essentials they need to
properly function, they can begin to fail. “Proper function” means that your heart’s blood
vessels, including arteries, are not damaged (narrowed or blocked). In your kidneys, this
means that waste products can be filtered out of your blood. In your eyes, this means
that the blood vessels in your retina (area of your eye that provides your vision) remain
intact. In your feet and nerves, this means that nerves are nourished and that there’s
blood flow to your feet. Diabetes causes damage that prevents proper function.
Unmanaged diabetes can lead to poor blood flow (poor circulation). Without oxygen and
nutrients (delivered in blood), you are more prone to the development of cuts and sores
that can lead to infections that can’t fully heal. Areas of your body that are farthest away
from your heart (the blood pump) are more likely to experience the effects of poor blood
flow. So areas of your body like your toes, feet, legs and fingers are more likely to be
amputated if an infection develops and healing is poor.
Yes. Because unmanaged diabetes can damage the blood vessels of the retina,
blindness is possible. If you haven’t been diagnosed with diabetes yet but are
experiencing a change in your vision, see primary healthcare provider or
ophthalmologist as soon as you can.
Scientists don’t have firm answers yet but there appears to be a correlation between
hearing loss and diabetes. According to the American Diabetes Association, a recent
study found that hearing loss was twice as common in people with diabetes versus
those who didn’t have diabetes. Also, the rate of hearing loss in people with prediabetes
was 30% higher compared with those who had normal blood glucose levels. Scientists
think diabetes damages the blood vessels in the inner ear, but more research is
needed.
Yes, it’s possible to develop headaches or dizziness if your blood glucose level is too
low – usually below 70 mg/dL. This condition is called hypoglycemia. You can read
about the other symptoms hypoglycemia causes in this article. Hypoglycemia is
common in people with Type 1 diabetes and can happen in some people with Type 2
diabetes who take insulin (insulin helps glucose move out of the blood and into your
body’s cells) or medications such as sulfonylureas.
Yes, it’s possible for diabetes to cause hair loss. Unmanaged diabetes can lead to
persistently high blood glucose levels. This, in turn, leads to blood vessel damage and
restricted flow, and oxygen and nutrients can’t get to the cells that need it — including
hair follicles. Stress can cause hormone level changes that affect hair growth. If you
have Type 1 diabetes, your immune system attacks itself and can also cause a hair loss
condition called alopecia areata.
People with Type 1 diabetes need insulin to live. If you have Type 1 diabetes, your body
has attacked your pancreas, destroying the cells that make insulin. If you have Type 2
diabetes, your pancreas makes insulin, but it doesn’t work as it should. In some people
with Type 2 diabetes, insulin may be needed to help glucose move from your
bloodstream to your body’s cells where it’s needed for energy. You may or may not
need insulin if you have gestational diabetes. If you are pregnant or have Type 2
diabetes, your healthcare provider will check your blood glucose level, assess other risk
factors and determine a treatment approach — which may include a combination of
lifestyle changes, oral medications and insulin. Each person is unique and so is your
treatment plan.
You aren’t born with diabetes, but Type 1 diabetes usually appears in childhood.
Prediabetes and diabetes develop slowly over time. Gestational diabetes occurs during
pregnancy. Scientists do believe that genetics may play a role or contribute to the
development of Type 1 diabetes. Something in the environment or a virus may trigger
its development. If you have a family history of Type 1 diabetes, you are at higher risk of
developing Type 1 diabetes. If you have a family history of prediabetes, Type 2 diabetes
or gestational diabetes, you’re at increased risk of developing prediabetes, Type 2
diabetes or gestational diabetes.
This means your kidneys are allowing protein to be filtered through and now appear in
your urine. This condition is called proteinuria. The continued presence of protein in
your urine is a sign of kidney damage.
There’s much you can do to prevent the development of diabetes (except Type 1
diabetes). However, if you or your child or adolescent develop symptoms of diabetes,
see your healthcare provider. The earlier diabetes is diagnosed, the sooner steps can
be taken to treat and manage it. The better you are able to manage your blood sugar
level, the more likely you are to live a long, healthy life.