Diabetes is a chronic, metabolic disease characterized by abnormally high blood sugar levels.
High blood sugar levels can do serious damage to the eyes, kidneys, and other organs. This is why it is vital to seek treatment if you suspect you may have diabetes.
It was estimated in 2019 that 37.3 million Americans—11.3 percent of the population—had diabetes. In addition, approximately 1.4 million Americans on average are diagnosed with diabetes per year.
What Is Blood Sugar?
Blood sugar refers to glucose molecules that are circulating throughout the bloodstream.
When blood sugar levels rise, the hormone insulin moves those sugar molecules from the bloodstream into the body’s cells. Cells use this glucose to supply their energy needs.
When there is not enough insulin or cells are resistant to it, sugar will build up to dangerous levels in the bloodstream.
Elevated blood sugar is a condition called hyperglycemia. Hyperglycemia is a hallmark feature of diabetes.
What Are the Common Types of Diabetes?
There are several types of diabetes:
- Type 1 Diabetes is an autoimmune disease that develops early in life. An autoimmune disease occurs when the body’s immune system attacks specific cells.
In a person with type 1 diabetes, insulin-producing cells of the pancreas are destroyed by the immune system’s T cells. This means that a person with type 1 diabetes cannot produce adequate insulin for survival.
There is no cure for type 1 diabetes, and type 1 diabetics need to receive insulin to stay alive. Approximately 5 percent of those with diabetes have type 1.
- Type 2 Diabetes occurs when the body becomes resistant to insulin, causing blood sugar levels to elevate. In response to high blood sugar levels, the pancreas releases more insulin. Over time, pancreas cells that produce insulin—beta cells—become impaired and cannot produce enough insulin to effectively lower blood sugar.
Type 2 diabetes is the most common type of diabetes and typically occurs in adults, but due to the increasing prevalence of obesity in children, there has been an increase in the number of children with Type 2 diabetes.
Type 2 diabetes can often be managed well with proper diet and exercise. Approximately 90 to 95 percent of individuals with diabetes have Type 2 diabetes.
- Gestational Diabetes is a form of diabetes that occurs during pregnancy (gestation). As with other forms of diabetes, blood sugar levels are elevated, which can affect the pregnancy and the baby’s health. Gestational diabetes can be managed well during pregnancy with proper diet, exercise, and medicine if needed. After childbirth, blood sugar levels typically return to normal, but having this form of diabetes means you have a greater risk of developing type 2 diabetes.
- Prediabetes is a condition in which blood sugar levels are higher than normal, but not high enough to be considered diabetes. Individuals with prediabetes have a 50 percent chance of developing diabetes over the next five to 10 years of being diagnosed. According to the U.S. Centers for Disease Control and Prevention, experts think that more than one in three Americans has prediabetes and the majority do not know it.
Other types of diabetes:
- Type 1.5 Diabetes is a form of diabetes also known as latent autoimmune diabetes in adults (LADA). It is similar to type 1 diabetes in that it is autoimmune; however, the onset occurs in adulthood rather than in childhood. Just like type 1 diabetes, there is no cure for type 1.5 diabetes and insulin must be taken daily.
- Type 3c Diabetes is a type of diabetes that occurs due to damage to the pancreas, other than autoimmune damage. The damage affects the pancreas’ ability to produce adequate insulin. Pancreatic cancer, cystic fibrosis, hemochromatosis, and pancreatitis can all cause damage to the pancreas that results in type 3c diabetes. Removal of the pancreas would also cause type 3c diabetes.
What Are the Symptoms and Early Signs of Diabetes?
Symptoms of diabetes include:
- Increased thirst and urination
- Increased hunger
- Unexplained weight loss
- Weakness and irritability
- Blurry vision
- Sores that heal slowly
- More frequent infections
- Numbness or tingling in the feet or hands
- Ketones in the urine
The symptoms present in the various types of diabetes are the same; however, the timeline for how quickly they develop is different.
Type 1 Versus Type 1.5 Diabetes
In type 1 diabetics, symptoms may start quickly, over just a few weeks. Type 1.5 diabetics may experience a slower onset of symptoms. In type 2 diabetics, symptoms tend to develop much more slowly, often over several years.
For types 1 and 1.5 diabetics, the situation may become life-threatening very quickly. People are particularly at risk of diabetic ketoacidosis if they do not receive adequate insulin.
Type 2 Versus Type 1 Diabetes
Some diabetes symptoms are more prevalent in Type 2 diabetes. For instance, type 2 diabetes may predispose individuals to neurodegenerative disorders, including Alzheimer’s disease.
An increased risk of vascular morbidities, like coronary heart disease and stroke, is also associated with Type 2 diabetes.
A 2021 review found patients with Type 2 diabetes exhibited higher levels of inflammatory markers in the bloodstream than type 1 diabetics.
In addition, Type 2 diabetics tend to experience sores that heal slowly and tingling nerves more frequently than type 1 diabetics.
What Are the Main Causes of Diabetes?
Type 1 and Type 1.5 Diabetes
In types 1 and 1.5 diabetes, T cells attack the insulin-producing cells—beta cells—of the pancreas. Scientists aren’t exactly sure what triggers the T cells to target the body’s own cells. There may be a combination of genetic and environmental factors at play.
Viral infections like those caused by enteroviruses (EVs), particularly coxsackieviruses B (CVB), may be one component that can trigger type 1 diabetes.
Type 2 Diabetes
In Type 2 diabetes, liver, fat, and muscle cells become resistant to insulin. Insulin is like a key that unlocks cells so glucose can be moved into the cell and used for energy. In Type 2 diabetes, the cells are not as responsive to the insulin present so the concentration of sugar in the bloodstream stays elevated.
In response to high blood sugar levels, the pancreas releases more insulin. Over time, insulin-producing beta cells become impaired and cannot produce enough.
During pregnancy, the placenta produces several hormones, such as estrogen, human placental lactogen, and cortisol, which can block some of insulin’s action.
Normally the pancreas can create more insulin to compensate for pregnancy-induced insulin resistance; however, in approximately 6 to 9 percent of pregnant Americans, the pancreas cannot keep up and gestational diabetes results.
Can COVID-19 Infection Trigger Diabetes?
COVID-19 infection may trigger the onset of diabetes in some individuals. Reports indicate an increased frequency of diabetes onset in patients following COVID-19 diagnosis.
New-onset diabetes has been detected after COVID-19 infection. To better understand this issue, a group of leading diabetes researchers has established a registry of patients with COVID-19-related diabetes.
The onset of autoimmune diabetes has been reported after COVID vaccination. In one case study, a 73-year-old Japanese woman was diagnosed with autoimmune diabetes eight weeks after receiving the second dose of the Moderna vaccine. The report, published in the Journal of Diabetes Investigation, notes the case study suggests there are “complicated immunological mechanisms for the destruction of β-cells associated with the vaccination.”
Who Is More Likely to Get Diabetes?
Types 1 and 1.5 Diabetes
Scientists believe there is a genetic component that predisposes a person, as well as environmental factors that may push the individual over the edge into autoimmunity. Having a sibling or parent with type 1 diabetes can increase the risk of an adolescent developing type 1 diabetes.
Type 2 Diabetes
Several factors increase your risk of Type 2 diabetes, including:
- Weight: Being overweight increases risk.
- Inactivity: Lack of physical activity increases risk.
- Family history: If you have a parent or sibling with type 2 diabetes, your risk increases.
- Abdominal fat: If you tend to store fat in your abdomen, you may be at an increased risk. Women with a waist circumference above 35 inches and men with a waist circumference of 40 or more inches have an increased risk.
- Blood lipid levels: Having high triglycerides and low levels of high-density lipoprotein (HDL) cholesterol increases your risk.
- Race and ethnicity: Blacks, Asians, Hispanics, Native Americans, and Pacific Islanders are more likely to develop Type 2 diabetes than Caucasians.
- Prediabetes: This is if your blood sugar is higher than normal but not high enough to be considered diabetes. If prediabetes is not addressed, it often leads to Type 2 diabetes.
- High blood pressure: Having high blood pressure increases your risk.
- Age: The risk for Type 2 diabetes increases with age, particularly after the age of 45.
- Gestational diabetes: If you experience gestational diabetes during pregnancy, your risk for diabetes increases.
- Polycystic ovary syndrome (POS): POS is a condition where the ovaries produce high levels of the wrong hormones. Obesity, irregular menstrual cycles, acne, and excessive hair growth are all associated with this condition.
You are more likely to have gestational diabetes if you have one or more of these risk factors:
- Family history of Type 2 diabetes
- Body mass index (BMI) over 30
- Are over age 35
- Had gestational diabetes in an earlier pregnancy
- Have given birth to a baby weighing more than nine pounds
What Are the Tests to Detect Diabetes?
Types 1 and 1.5 Diabetes
It is relatively straightforward to diagnose types 1 and 1.5 diabetes. If you or your child have symptoms of diabetes, your health care provider will do the following tests:
- Blood glucose test: This test is performed to determine the amount of sugar in your bloodstream. It may be a random test (fasting not required) or a fasting test. Results showing high blood sugar levels are indicative of diabetes.
- Antibody test: Autoantibodies are proteins that target the body’s own tissues by mistake. An antibody blood test checks for autoantibodies. The presence of specific autoantibodies indicates autoimmune diabetes—type 1 if you’re a child and type 1.5 if you are an adult. Individuals with Type 2 diabetes do not typically have autoantibodies that target the pancreas.
- Glycosylated hemoglobin test (A1C): If the results of blood glucose testing suggest you or your child may have diabetes, your health care provider may order an A1c test. This is a simple blood test that determines the average amount of glucose in your bloodstream over the past three months.
Your provider may also order these tests to get an idea of your overall health and to see if you have ketoacidosis:
- Urinalysis: This is a simple urine test that checks for ketones, the acids your body produces when you are not sufficiently moving blood sugar into cells for them to use for energy. A high concentration of ketones in the bloodstream can cause the blood to become acidic, which can be fatal if not treated.
- Basic metabolic panel: This blood test measures a handful of substances in the bloodstream, giving the provider an idea of your overall health.
Type 2 Diabetes
There are several tests your provider will use to assess whether you have Type 2 diabetes:
- Fasting plasma glucose test: For this test, you will not be able to eat or drink more than a few sips of water for eight hours before the test. This is a blood test that checks your blood sugar levels in a fasting state. A result of 100 to 125 mg/dL indicates prediabetes and a result of 126 mg/dL or higher is indicative of diabetes.
- Random plasma glucose test: This is a blood test that can be done at any time, regardless of whether you are fasting. This test measures your blood sugar levels. A result of 140 to 199 mg/dL is indicative of prediabetes, while a result of 200 mg/dL or higher is indicative of diabetes.
- Oral glucose tolerance test: This test assesses your blood sugar level before and after you consume a high-sugar drink. The provider is then able to see how your body responds to a high-sugar challenge. A result of 200 mg/dL or higher is indicative of diabetes.
- Glycolated hemoglobin testing (A1c): This is a simple blood test that determines the average amount of glucose in your bloodstream over the past three months. The result is specified as a percentage. A normal A1c is below 5.7 percent. A result of 6.5 percent or higher is indicative of diabetes. A1c levels tend to be higher in people who identify as non-Hispanic black versus those who identify as white.
What Are the Complications of Diabetes?
High concentrations of sugar in the bloodstream are damaging to capillaries, the small blood vessels through which oxygen diffuses to the body’s tissues. When an individual does not carefully control their blood sugar levels, these capillaries can become damaged and the surrounding tissue injured from poor circulation.
In the event of capillary damage, the following complications may occur:
- Diabetic neuropathy: Nerves are damaged leading to numbness, tingling, and pain. Typically, these sensations begin at the ends of the toes and spread upward. When the nerves associated with digestion are damaged, this can lead to nausea, constipation, or diarrhea. Men may experience erectile dysfunction due to diabetic neuropathy.
- Diabetic retinopathy: The blood vessels supplying the retina with oxygen are very delicate and can be damaged by ongoing high blood sugar levels. The retina is the layer of cells that detects light. When blood sugar levels are not controlled, serious damage can occur in the retina, potentially leading to blindness.
- Diabetic nephropathy: Each kidney contains millions of delicate specialized capillaries called glomeruli. These glomeruli are vital for filtering waste and extra fluid out of the bloodstream. Prolonged high blood sugar levels damage these capillaries and may lead to kidney failure.
Failure to keep blood sugar levels at a healthy concentration may also lead to:
- Cardiovascular disease
- Hearing impairments
What Is Diabetic Ketoacidosis?
Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes. DKA develops when there is not enough insulin to sufficiently move the blood sugar molecules into cells. When this occurs, the liver gets a signal to break down fat for the cells to use as fuel—then acids, called ketones, are produced. At a certain point, the level of ketones produced becomes toxic.
Symptoms associated with DKA should be taken seriously:
- Blood sugar stays at or above 300 mg/dL
- Fruity breath odor
- Deep, rapid breathing
- Stomach pain
What Are the Treatments for Diabetes?
Treating and managing diabetes effectively requires a multifaceted approach. There are three main aspects to managing diabetes.
1. Blood Sugar Monitoring
It is crucial to keep an eye on your blood sugar levels if you have diabetes. You will need to monitor your blood sugar frequently with a continuous glucose monitor (CGM) or a glucose meter and finger stick.
Individuals with types 1 and 1.5 diabetes need to have insulin to live. Some individuals with Type 2 diabetes need insulin as well.
There are several methods for getting insulin into the body: through injection with a syringe, through an insulin pump, through an insulin pen, or with rapid-acting inhaled insulin. There are a few different types of synthetic insulin available; they each have a specific period of activity. Your health care provider will work with you to determine the best type of insulin for you.
3. Oral Diabetes Medications
Oral diabetes medications are taken by mouth and help those with Type 2 diabetes who produce some insulin to manage their diabetes more effectively. Several classes of oral diabetes medicines use different methods to help manage blood sugar levels. They include:
- Alpha-glucosidase inhibitors: These help decrease blood sugar by stopping the breakdown of starches—such as bread and potatoes—in the small intestine. Starch is made of thousands of glucose molecules. If starch cannot be broken down, those glucose molecules will not be free to enter the bloodstream from the small intestine, where nutrient absorption occurs.
- Biguanides: The action of biguanides is two-fold: Compounds lower the amount of glucose the liver releases into the bloodstream, and increase the sensitivity of muscle tissue to insulin. Both actions help regulate blood sugar levels. Metformin, a biguanide, is the most popularly prescribed oral medication for Type 2 diabetes.
- Bile acid sequestrants (BASs): These sequestrants help remove LDL cholesterol and seem to help lower blood sugar levels.
- DPP-4 inhibitors (gliptins): GLP-1 is a compound in the body that lowers blood glucose levels; however, it breaks down quickly so the effect is shortened. Gliptins prevent GLP-1 from breaking down quickly, so GLP-1 can continue to lower blood sugar levels for a longer period.
- Meglitinides (glinides): These compounds tell your pancreas to release insulin. They are taken before your meal to help with blood sugar control.
- SGLT2 inhibitors: These cause the kidneys to release glucose from the bloodstream into the urine. This has the effect of lowering blood glucose levels.
- Sulfonylureas: Like meglitinides, these compounds tell your pancreas to release insulin.
- Thiazolidinediones (TZDs): These compounds have a two-fold effect: They decrease the amount of glucose the liver produces, and they increase the sensitivity of fat and muscle tissue to insulin.
Exercise and Diet
Exercise is pivotal in helping to manage diabetes. Physical activity increases the body’s sensitivity to insulin, thus lowering insulin resistance.
Diet is a key part of managing diabetes. It is important to eat unprocessed foods such as fruits, vegetables, and whole grains. Avoid trans fats. Eat sufficient protein and fiber with fewer refined carbohydrates to help you keep your blood sugar levels from elevating quickly and to an unhealthy level. You should keep track of how many carbohydrates you eat to maintain better control over blood sugar levels.
How Does Your Mentality Affect Diabetes?
A good mindset may also help you manage or reduce the risks of diabetes.
Longitudinal studies indicate that the following mentalities may all increase your risk of developing Type 2 diabetes:
- Emotional stress
These all cause the body stress.
When your body is stressed, you release cortisol. Cortisol is a great hormone for helping you survive a stressful event. It assists with the fight or flight response, where the body gears up to either fight or run away.
Cortisol has a strong antagonistic effect on the secretion and signaling of insulin. Cortisol in muscle tissue decreases the glucose transporter 4 (GLUT4) on the surface of the cell.
Insulin circulating in the bloodstream normally binds to GLUT4 so the transporter can move glucose molecules into the cell. If there are fewer GLUT4 transporters due to cortisol, then insulin cannot “unlock” that cell to help glucose move inside the cell.
This translates into increased levels of sugar in the bloodstream.
It would be fine if stress only happened on occasion. However, the stress of the modern individual is ongoing. In the long run, it may cause insulin resistance and lead to diabetes.
What Are the Natural Remedies for Diabetes?
While a diagnosis of Type 2 diabetes sounds permanent, studies indicate some people can reverse the disease. Being in remission from diabetes means being able to keep your blood sugar levels in a healthy range without medication. One parameter is when hemoglobin A1C concentrations are at a certain threshold after weight loss and six months later without the use of medicine.
Reversing diabetes is often possible and the key is a healthy diet and an active lifestyle.
Several botanicals show promising results in helping the body achieve healthy glucose levels. These include:
- Bitter melon
- Prickly pear cactus
How Can I Prevent Diabetes?
Type 1 Diabetes
No one can prevent types 1 and 1.5 diabetes. These two types are autoimmune. Scientists aren’t exactly sure what triggers T cells to target the body’s own cells.
Type 2 Diabetes
You can drastically reduce your risk of Type 2 diabetes by following these steps:
- Physical activity: Aim for at least 30 minutes of aerobic activity five days a week. Physical activity increases the body’s sensitivity to insulin, thus lowering insulin resistance.
- Lose weight: If you are overweight, losing even 5 to 7 percent of your body weight can help you maintain better control of your blood sugar.
- Eat whole, unprocessed foods: It is important to eat foods naturally high in fiber, such as fruits, vegetables, and whole grains. Avoid processed foods and trans fats. Eating sufficient protein with fewer refined carbohydrates and sugar will help you keep your blood sugar levels from elevating quickly and to an unhealthy level.
- Manage stress: Since cortisol can have a massive blocking effect on insulin, try to find ways to reduce stress.
- Don’t go overboard on alcohol: A meta-analysis of more than 1.9 million individuals revealed heavy consumption of alcohol raises the risk of type 2 diabetes for many people.
Medical reviewed by Tia Delaney-Stewart, MSN-Ed, RN, PHN,CCM.