Diabetes

Although there are several types of Diabetes, Diabetes is a metabolic disorder that involves the release of insulin from the pancreas and its use in the body in order to process and store Glucose (sugar) within the body.  Glucose is an important source of energy, however, too much can negatively impact health.

Types of Diabetes include:

• Type 1
• Type 2
• Gestational
• Prediabetes (Mayo, 2018)

In Type 1 Diabetes, an individual's immune system destroys the cells of the pancreas that produce insulin.  This greatly reduces the amount of insulin being produced.  Without insulin or very little insulin, the amount of blood sugar in the body increases (Mayo, 2018).There is a genetic proponent to Type 1 Diabetes.  Prediabetes is a step to developing Type 2 Diabetes.  In Prediabetes, cells within the body become increasingly resistant to insulin.  Regardless of how hard the pancreas works, it cannot make enough insulin to counteract the insulin resistance (Mayo, 2018).  This leads to blood glucose increasing instead of being used by cells for energy.  At this point, someone has developed Type 2 Diabetes.  There is also a genetic aspect to  Type 2 Diabetes.  Increased weight is also linked to developing Type 2 Diabetes (Mayo, 2018).  Gestational Diabetes occurs due to hormones, produced by the placenta, causing cells to be resistant to insulin.  There are instances where the pancreas is unable to produce enough insulin to counteract the resistance (Mayo, 2018).  Typically, Type 1 Diabetes is diagnosed in children and younger adults, but can be diagnosed at any age.  Type 2 Diabetes is typically diagnosed in adulthood, but  can be also diagnosed in children as well.  Gestational Diabetes is diagnosed during pregnancy (NIH, 2016).

There are approximately 50.2 million people, 18 years or older, in the United States with Diabetes, either diagnosed or undiagnosed (MNT, 2020).  This equates to almost 10% of the population.  More than 25% do not know that they have Diabetes (NIH, 2016).

Symptoms of Diabetes (including Gestational) include:

• Extreme hunger
• Fatigue
• Increased urination
• Increased thirst
• Dry mouth
• Itchy skin
• Blurred vision
• Impotence/Erectile dysfunction

Symptoms of Type 1 Diabetes include:

• Unexplained weight loss
• Nausea
• Vomiting
• Velvety dark skin changes of neck, armpits, and groin (Acanthosis Nigricans)
• Decreased vision

Symptoms of Type 2 Diabetes include:

• Yeast infections
• Slow healing sores or cuts
• Pain or numbness (Mayo, 2018)(WebMD, 2019)

Complications from Diabetes can arise.  Diabetes can play a part in developing conditions such as:

• Heart disease
• Stroke
• Kidney disease
• Eye problems
• Dental disease
• Nerve disease
• Foot problems
• Hearing impairment
• Alzheimer's disease
• Depression (Mayo, 2018)(NIH, 2016)

With Gestational Diabetes, complications that can occur include:

• Excess growth (Large baby)
• Baby more likely to develop Type 2 Diabetes later in life
• Low blood sugar
• Death (Mayo, 2018).

There are many risk factors for Diabetes.  They include:

• For Type 1:
• Family history
• Environmental factors
• Presence of damaging immune system cells (autoantibodies)
• Geography
• For Prediabetes/Type 2:
• Family history
• Weight
• Physical inactivity
• Race
• Age
• Gestational diabetes
• Polycystic Ovary Syndrome
• Hypertension
• High Cholesterol
• Gestational
• Age
• Family history
• Personal history
• Weight
• Race (Mayo, 2018).

With the symptoms occurring rapidly with Type 1 Diabetes, screening tests for Diabetes are often warranted.  With Type 2 Diabetes and Prediabetes, there are guidelines set forth by the American Diabetic Association to prompt screening for Diabetes including:

• BMI >25, regardless of age
• 45 years old or older
• Any woman that had Gestational Diabetes during a pregnancy
• Diagnosis of Prediabetes (Mayo, Diagnosis, 2018).

Tests used to diagnose Diabetes include:

• Glycated Hemoglobin (A1C) test
• Random blood sugar
• Fasting blood sugar
• Oral glucose tolerance test
• Urine checked for ketones, if Type 1 is suspected 
• Glucose challenge test, used to diagnose Gestational Diabetes

There are several treatments that can be used with Diabetes.  These treatments include:

• For Type 1
• Insulin
• Injections
• Insulin pump
• Blood sugar checks
• Carbohydrate Counting
• For Type 2
• Lifestyle changes
• Exercise
• Weight loss
• Well-balanced diet
• Minimal alcohol 
• Medications
• Metformin
• SGLT2 inhibitors
• GLP-1 receptor agonists
• Bariatric surgery (Mayo, 2018).

With all types of Diabetes, an individual should be aware of the symptoms of hypoglycemia, hyperglycemia, Diabetic Ketoacidosis, and Hyperglycemic Hyperosmolar Nonketotic Syndrome as they all can constitute an emergency. Individuals with Diabetes should be aware of the symptoms of each of these conditions.   Hypoglycemia, or low blood sugar, occurs when someone's blood sugar falls below a target level.  Hyperglycemia occurs when blood sugar raises above a target level.  Diabetic ketoacidosis occurs when the body breaks down fat for energy producing ketones.  Hyperglycemic Hyperosmolar Nonketotic Syndrome occurs with Type 2 Diabetes when the blood sugar level becomes so high that an individuals' blood thickens (Mayo, 2018).

Symptoms of Hypoglycemia include:

• Sweating
• Shakiness
• Weakness
• Hunger
• Dizziness
• Headaches
• Blurred vision

Symptoms of Hyperglycemia include:

• Frequent urination
• Increased thirst
• Dry mouth
• Blurred vision
• Fatigue
• Nausea

Symptoms of Diabetic Ketoacidosis include:

• Loss of appetite
• Weakness
• Fever
• Numbness
• Stomach pain
• Sweat, fruity breath

Symptoms of Hyperglycemic Hyperosmolar Nonketotic Syndrome include:

• Blood sugar 600 mg/dL or higher
• Fever
• Dry Mouth
• Extreme thirst
• Drowsiness
• Confusion
• Vision loss
• Hallucinations (Mayo, 2018).

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For more resources on Diabetes, visit the American Diabetic Association website at https://www.diabetes.org/resources

Mayo Clinic. (2018)  Diabetes.  Mayo Clinic.  Retrieved from https://www.diabetes.org/resources

Medical News Today. (2020) Diabetes: Symptoms, treatment and early diagnosis.  Medical New Today.  Retrieved from https://www.medicalnewstoday.com/articles/323627

NIH. (2016) What is Diabetes?  National Institute of Diabetes and Digestive and Kidney Diseases.  Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes

WebMD. (2018) Early Signs and Symptoms of Diabetes: How To Tell If You Have It.  WebMD.  Retrieved from https://www.webmd.com/diabetes/guide/understanding-diabetes-symptoms