Diabetes

The three most common symptoms of undiagnosed diabetes are the need to urinate often, feeling extremely thirsty, and increased hunger. Symptoms vary for each individual and include:

• Excessive thirst
• Frequent urination
• Extreme hunger
• Chronic fatigue
• Weight loss (sudden or unexplained)
• Irritability
• Blurred vision
• Sores or wounds that heal slowly
• Dry, itchy skin
• Frequent infections (i.e., skin, gum, and vaginal)
• Fruity-smelling breath or urine
• Numbness and tingling of the hands and feet

There are several types of diabetes in this family of metabolic diseases, however, the majority of cases fall under two categories, type 1 and type 2. Type 1 is an auto-immune type and Type 2 is acquired, but both have a genetic link. Gestational diabetes is also discussed due to its occurrence in pregnant women.

Type 1 diabetes (T1D).Accounts for 5-10% of all cases of diabetes. Also called juvenile diabetes or insulin-dependent,T1D symptoms usually appear in childhood, but can appear anytime into early adulthood. In type 1 diabetes, the pancreas no longer produces insulin and the body is unable to process any glucose without taking daily insulin injections. This is thought to be an auto-immune disorder that is triggered by either a virus or environmental factors. There is no cure and this type is not reversible, but it is manageable requiring lifelong treatment with insulin injections.

Type 2 diabetes (T2D).Also called non-insulin-dependent diabetes mellitus, or NIDDM. This type of diabetes accounts for 90-95% of all known cases of diabetes. T2D usually occurs in the adult years, but the age of onset is decreasing. The pancreas decreases or stops the production of insulin and the body has reduced sensitivity to any insulin present. There is usually a cause linked to the following: obesity, family history, history of gestational diabetes, and ethnic background (Native American, African American, Hispanic). The good news is this type is highly treatable and even reversible if the pancreas is still functioning. You may or may not require insulin injections and it is often manageable with diet and/or oral medications.

Gestational diabetes. This sub-type of type 2 diabetes only occurs during pregnancy. It is more common in women who are obese and have a history of Polycystic Ovarian Syndrome (PCOS). Babies born to mothers with GD have a risk of being higher birthweight and low blood sugar at birth. This condition is easily managed during pregnancy with good medical care and diet.

The causes of each type of diabetes are different. These are:

Type 1 Diabetes
When you have Type 1 Diabetes, the pancreas no longer produces insulin, and the blood sugar stays in the blood and does not get into the cells.

Insulin works by:

1. Your body breaks down the food you eat into glucose.
2. Insulin is secreted into the blood from the β-cells of islets of Langerhans.
3. The insulin opens the gates that allow the sugar to get into your cells.
4. Insulin helps keep the blood sugar levels in check.
5. If your blood sugar is in the normal range, your pancreas lowers the insulin levels
6. Your liver produces a glucose-containing substance called glycogen.
7. Your liver stores glycogen for times when you do not have enough blood glucose.

Something triggers the body’s immune system to attack the islets of Langerhans cells of the pancreas and destroy the β-cells, the cells that produce insulin. When enough of the islet cells in the pancreas ceasesto function, insulin is no longer produced. There are possible genetic factors that raise the risk of Type 1 diabetes and/or autoimmune disorders.

Type 2 Diabetes
A combination of lifestyle factors (obesity, poor diet, and lack of exercise) and family history all contribute to the development of Type 2 diabetes. In this case, there is no autoimmune destruction of the β-cells as a causative factor. The insulin-producing cells in the pancreas still work but produce less insulin than the body requires. Further, the body cells are insulin-resistant and require more insulin to allow glucose into the cells.

The risk factors associated with type 1 diabetes are unknown, but genetics and some viruses may contribute to a higher risk of developing this form of diabetes. Risk factors associated with type 2 diabetes are:

• Age (45 or older)
• Obesity
• Low physical activity
• Family history of diabetes
• Ethnicity (African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander)
• High blood pressure
• Depression
• History of heart disease or stroke
• History of gestational diabetes
• Polycystic ovary syndrome
• Have acanthosis nigricans (dark, thick, and velvety skin around neck or armpits)

Diabetes can be very silent for years, without any outward symptoms until the disease progresses. If you do not have symptoms, the disease is often found during a routine physical. It is highly recommended that anyone age 45 and older be screened routinely for diabetes every three years. If you do have any of the above symptoms, see your doctor as soon as possible. The following tests are used to diagnose diabetes:

Random blood sugar test. During a routine office visit, your doctor can just take a small sample of blood from your finger and test it for blood sugar. Whether you have eaten or not, if your blood sugar is 200 mg/dL or higher you may have diabetes.

Fasting blood sugar test. You will fast after bedtime the night before and have nothing to eat or drink the morning before your test. They will take a blood sample and test it for blood sugar. It should be lower than 100 mg/dL and if it is between 100 mg/dL and 125 mg/dL you may have prediabetes. Over 125 mg/dL two times means you have diabetes.

Glucose tolerance test. This blood test requires fasting the night before the test and the morning of the test. When you first get to the lab they will draw a blood sample and then have you drink a very sweet glucose drink. After drinking the solution, they will draw your blood every two hours to see how your body processes glucose. If your blood sugar drops to 140 mg/dL or less after two hours, your body handles glucose normally. If your blood sugar stays above 200 mg/dL then you may have diabetes. If your blood sugar stays between 140 mg/dL and 100 mg/dL then you may have prediabetes.

The A1C test. The glycated hemoglobin A1C test checks the average of your blood sugar levels over three months. When your blood sugar rises, it sticks to the hemoglobin in your blood and stays there. Even if you have normal blood sugar levels during random testing, this test will pick up that you may have had high blood sugars over the three months. The test levels that indicate your blood sugars work like this:

• A1C 5.7 or lower – Normal
• A1C 5.7 to 6.4 – Prediabetes
• A1C 6.5 or higher – Diabetes if this number comes up on two different occasions
  If you are diagnosed with diabetes, it is recommended that you have the A1C test done 2 to 4 times yearly. It is recommended that you try to keep your A1C less than 7, but your doctor will tell you the best numbers for your age and other health conditions you may have.

You will also keep track of your daily blood sugar levels either twice daily or before each meal if you take insulin.

Other tests. To check for any complications your doctor may test:

• Liver function tests
• Thyroid function tests
• Kidney function tests
• Cholesterol testing
• Blood pressure
• Eye examinations
• Foot examinations

The treatments for diabetes include:

• Eating a healthy balanced diet
• Exercise
• Diabetic medications (oral antidiabetics and/or insulin injections)
• Daily blood sugar monitoring

Eating a healthy balanced diet. A diabetic diet consists of balanced low-calorie, low-fat, and healthy carb foods. It is also important to eat foods that are high in fiber such as fresh vegetables, fresh fruits, and whole grains. Try to avoid processed foods, high-fat foods, and desserts.

The good news is that diabetics can have carbohydrates if they are low on the “glycemic index.” Recent studies have shown that certain carbohydrates break down slower than refined carbohydrates and benefit a diabetic diet. Adding protein foods to carbohydrates also slows down blood sugar spikes. A diabetic educator can help you with your meal plans that will keep your blood sugar in a good range.

Exercise. Diabetics need to get 30 minutes of exercise at least 5 days a week. This includes; swimming, walking quickly, and riding a bike. Aerobic exercise at least 3 days a week can help lower blood sugar levels and improve circulation.
Exercise brings down the blood sugar levels so it is important to check your blood sugar before and after exercise, eat a light carb snack before you start and after you finish and stop physical activity if you have symptoms of low blood sugar including; dizziness, sweating, confusion, or shakiness.

Diabetic medications. If you have Type 1 diabetes you will need insulin injections since your pancreas no longer makes insulin. You may also need other medications to prevent complications.If you have Type 2 diabetes, you may be able to control your blood sugar levels with dietary management alone. You may also need oral antidiabetics to help your body process glucose and increase insulin production from the pancreas. In more advanced Type 2 diabetes, some people need to also take oral insulin medications or insulin injections.

Blood sugar monitoring. Diabetes checking your blood sugar at least twice a day. Type 1 diabetics need to check before each meal to know how much insulin to take. The traditional method is using a standard glucose meter which requires at least two finger pricks each day to check the sugar level. However, the FDA has approved continuous glucose-monitoring devices that do not require a finger prick. These devices monitor your glucose level throughout the day using a variety of different sensor methods, including a patch worn on your stomach or a device around your upper arm. It is vitally important to monitor so you know when your blood sugar is either too low or too high. Symptoms of these include:

Low Blood Sugar

• Weakness
• Fatigue
• Shakiness
• Sweating
• Confusion
• Hunger
• Headache
• Irritability
• Anxiety
• Blurred vision
• Fast heartbeat
• Fainting
• Seizures

High Blood Sugar

• Excessive urination
• Excessive thirst
• Blurred vision
• Dry skin
• Weakness
• Fatigue

The symptoms for both Type 1 and Type 2 diabetes are pretty much the same. Type 2 diabetes and gestational diabetes symptoms may tend to be mild or not even appear until the disease has progressed. They include:

• Urinary frequency
• Excessive thirst
• Excessive hunger
• Severe fatigue
• Blurred Vision
• Slow healing
• Loss of weight (Type 1)
• Pins and needles or pain in the legs, hands, and feet

Type 1 diabetes may not be preventable because it is a genetic and autoimmune condition. Type 2 diabetes is preventable and reversible in the early stages of the disease. Prevention tips include:

• Keep your weight in a healthy range
• Get plenty of exercises
• Eat healthily
• Get your blood sugar checked at your yearly physical
• Avoid stress

Learn the glycemic index. The glycemic index is based on how high carbohydrates will raise your blood sugar. There are low glycemic carbs, moderate glycemic carbs, and high glycemic carbs. This will help you include healthy carbs in your diet.

Increase fluid intake. Increased sugar-free fluids can help flush excess sugar from your body and protect your health.

Check restaurant menu options. Before you go out to eat, check ahead to make sure there are menu options that are “diabetic friendly.” If you are in a pinch and don’t have time, opt for the “heart-healthy” choices.

Let people know about your condition. People around you need to know that you are diabetic. Teach them about symptoms of low or high blood sugar and how to help you if you become unconscious or unable to care for yourself.

Keep blood sugar rescue on hand. If you do have a drop in blood sugar, you will need to have some kind of blood sugar rescue available. If you can manage yourself, keep things like orange juice, hard candies, or glucose rescue tablets on hand. You will also need a glucose pen injection and the people around you will need to know how to use it.

If your blood sugar stays too high for too long, you may develop complications. Some may be very severe and can result in death. These complications include:

Heart disease. People with diabetes have an increased risk of heart disease. High blood sugar narrows the arteries and can result in a heart attack or stroke.

Nerve damage. High blood sugar damages the blood vessels that feed your nerves. This is most common in the feet and legs. If you lose these nerves, you may not feel an injury or infection and can lead to amputation. The nerves in your stomach can also be damaged and cause digestion problems.

Kidney disease. The sugar in your blood may damage the filters in your kidneys and they can begin to fail. If they fail, you may need to go on dialysis and/or need a kidney transplant.

Eye disease. High blood sugar affects the tiny blood vessels that supply your retina with blood. Diabetes can lead to a disease known as “diabetic retinopathy” and can cause blindness, cataracts, or glaucoma.

Other conditions stemming from diabetes include:

• Fungal infections
• Hearing loss
• Increased risk of Alzheimer’s disease

A study from the University of Florida is researching the use of combination therapy using the drugs Thymoglobulin® (ATG) and Neulasta® (GCSF) to reverse type 1 diabetes after it has been established. Results from the study showed that the cells that produce insulin retained function after treatment. There are also several clinical trials that you can learn about here through the National Institute of Diabetes and Digestive and Kidney Diseases.

American Diabetes Association. (2013, January). Diagnosis and classification of diabetes mellitus. Diabetes Care, 36(Supp. 1), S67-S74. Retrieved from:https://care.diabetesjournals.org/content/diacare/36/Supplement_1/S67.full.pdf

Centers for Disease Control and Prevention. (2020, March 11). Type 1 diabetes. Retrieved fromCenters for Disease Control and Prevention:https://www.cdc.gov/diabetes/basics/type1.html

Centers for Disease Control and Prevention. (2020, March 11) Type 2 diabetes. Retrieved fromCenters for Disease Control and Prevention:https://www.cdc.gov/diabetes/basics/type2.html

Food and Drug Administration Writing Staff. (2016, December 20). FDA expands indication for continuous glucose monitoring system, first to replace fingerstick testing for diabetes treatment decisions. Retrieved from:https://www.fda.gov/news-events/press-announcements/fda-expands-indication-continuous-glucose-monitoring-system-first-replace-fingerstick-testing

Fowler, M. J. Microvascular and macrovascular complications of diabetes. Clinical Diabetes, 29(3), 116-122. Retrieved from:https://clinical.diabetesjournals.org/content/diaclin/29/3/116.full.pdf

Mayo Clinic Staff. (2020, January 30). Type 1 diabetes in children. Retrieved from Mayo Clinic:https://www.mayoclinic.org/diseases-conditions/type-1-diabetes-in-children/symptoms-causes/syc-20355306

National Institute of Diabetes and Digestive and Kidney Diseases. (2016, November). Risk factors for type 2 diabetes. Retrieved from:https://www.niddk.nih.gov/health-information/diabetes/overview/risk-factors-type-2-diabetes