Diabetes

The Centers for Disease Control and Prevention estimates about 30.3 million people (9.4% of the US population) have diabetes. Among the people with diabetes, 7.2 million don’t even know they have it. About 1.4 million new cases of diabetes are diagnosed every year. 

Diabetes is a chronic disease that affects how your body turns food into energy. Most of the food you eat is broken down into sugar and released into your bloodstream. Your pancreas makes insulin, which acts like a key to let the blood sugar (or blood glucose) into you body’s cells to be used as energy. 

When you have diabetes, insulins does not work as it should and too much blood sugar is in your bloodstream, instead of being used as energy in the body’s cells. Over time, high blood glucose can lead to serious problems with your heart, eyes, kidneys, nerves, and gums and teeth. Early detection and treatment of diabetes can decrease the risk of developing the complications of diabetes. 

Types of Diabetes

Prediabetes & Type 2

  • Prediabetes
  • Types 2 Diabetes
  • Risk Factors for Prediabetes & Type 2
  • Prevention

More than 84 million American adults have prediabetes. Research suggest 1 in 3 adults have prediabetes, and of this group, 90% don’t know they have it. Prediabetes is when your blood sugar is higher than normal, but not high enough to be diagnosed with diabetes. People with prediabetes are at high risk of type 2 diabetes, heart disease, and stroke. Progression from prediabetes to type 2 diabetes isn’t inevitable. Eating healthy foods, adding physical activities to your daily routine and maintaining a healthy weight can help bring your blood sugar level back to normal.

The exact cause of prediabetes is unknown. But family history and genetics appear to play an important role. Inactivity and excess fat — especially abdominal fat — also seem to be important factors. What is clear is that people with prediabetes don’t process sugar (glucose) properly anymore. As a result, sugar collects in the bloodstream instead of doing its normal job of fueling the cells that make up muscles and other tissues.

Prediabetes affects adults and children and generally has no signs or symptoms. One possible sign that you may be at risk of type 2 diabetes is darkened skin on certain parts of the body – neck, armpits, elbow, knees, and knuckles. See your doctor if you’re concerned about diabetes or if you notice any type 2 diabetes signs or symptoms. Ask your doctor about blood glucose screening if you have any risk factors for prediabetes.

Who’s At Risk
  • Are overweight
  • Are 45 or older
  • A family member has type 2 diabetes
  • Physically active less than 3 times a week
  • Had gestational diabetes, or gave birth to a baby who weighted more than 9 pounds

Type 2 diabetes is the most common form of diabetes. It accounts for 90-95% of people with diabetes. More and more children and adolescents are being diagnosed with prediabetes and type 2 diabetes every year. 

In type 2 diabetes, the body does not use insulin well. Because of this, blood sugar levels increase, but the body can’t bring it down on its own. High blood sugar (hyperglycemia) in type 2 diabetes is due to a condition called insulin resistance. The presence of high blood sugar due to insulin resistance and a drop in insulin production is what makes type 2 different from other types of diabetes.

At first, the pancreas makes extra insulin to make up for the body’s insulin resistance. But, over time it isn’t able to keep up and can’t make enough insulin to keep your blood sugar at normal levels. Insulin resistance doesn’t develop immediately, and often, people with the condition don’t show symptoms — which may make getting a diagnosis harder. You have a higher risk of type 2 diabetes if you are older, have obesity, have a family history of diabetes, or do not exercise. Having prediabetes also increases your risk. 

When glucose levels build up in the blood instead of going into the cells, it can cause two problems:

  1. Right away, your cells may become starved for energy
  2. Over time, high blood glucose levels may hurt your eyes, kidneys, nerves, or heart
Blood tests can show if you have diabetes. One type of test, the A1C, can also check on how you are managing your diabetes. People with Type 2 diabetes can control or manage their blood glucose with healthy eating and being active. But, your doctor may need to also prescribe oral medications or insulin pumps to help you meet your target blood glucose levels. Type 2 diabetes usually gets worse over time – even if you don’t need medications at first, you may need to later on.  
 
Who’s At Risk
  • Have prediabetes
  • Are overweight
  • Are 45 or older
  • A family member has type 2 diabetes
  • Physically active less than 3 times a week
  • Had gestational diabetes
Type 2 diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population. 
 
Type 2 Diabetes and Pregnancy
During pregnancy, diabetes impacts that health of the mother and the baby. Pregnant women with poorly controlled diabetes are at higher risk for miscarriage, stillbirth, premature birth, larger than average babies, and birth defects.If you’re planning to get pregnant, work with your doctor ahead of time to get your Hb A1c level as close to goal as possible. Review your medications with your health care provider and pharmacist to make sure that they will be safe for the baby when you do conceive.
  • Weight – Being overweight is a primary risk factor. The more fatty tissue you have, the more resistant your cells become to insulin.
  • Waist size – A large waist size can indicate insulin resistance. The risk of insulin resistance goes up for men with waists larger than 40 inches and larger than 35 inches for women. 
  • Dietary patterns – Eating red meat and processed meat, drinking sugar-sweetened beverages, is associated with a higher risk of prediabetes. A diet high in fruits, vegetables, nuts, whole grains, and olive oil is associated with a lower risk of prediabetes.
  • Inactivity – The less active you are, the greater your risk of prediabetes. Physical activity helps you control your weight, use up glucose as energy, and makes your cells more sensitive to insulin. 
  • Age – Although diabetes can develop at any age, the risk of prediabetes increases after age 45. This may be because people tend to exercise less, lose muscle mass, and gain weight as they age.
  • Family history – Your risk of prediabetes increase if you have a parent or sibling with with type 2 diabetes.
  • Race – Although it’s unclear why, people of certain races – including African American,, Hispanic, Native Americans, Asian-Americans and Pacific Islanders – are more likely to develop diabetes. 
  • Gestational diabetes – If you develop gestational diabetes while pregnant, you and your child are at higher risk of developing prediabetes. If you gave birth to a baby who weighted more than 9 pounds, you’re also at increased risk of prediabetes. 
  • Polycystic Ovary Syndrome (PCOS) – This hormone-related medical condition increases women’s risk of prediabetes. 
  • Sleep – People with certain sleep disorders (like obstructive sleep apnea) have increased risk of insulin resistance. People who work changing shifts or night shifts, possibly causing sleep problems, also may have an increased risk of prediabetes or type 2 diabetes.

Research shows that you can do a lot to reduce your chances of developing type 2 diabetes. 

  • Lose weight and keep it off – You may be able to prevent or delay diabetes by losing 5-7% of your starting weight. For instance,  if you weigh 200 pounds, your goal would be to lose about 10-14 pounds. 
  • Exercise – Get at least 30 minutes of physical activity 5 days a week. If you have not been active, talk with you health care professional about which activities are best. Start slowly to build up to your goal. 
  • Eat healthy foods – Eat smaller portions to reduce the amount of calories you eat each day and help you lose weight. Choosing foods with less fat is another way to reduce calories. Drink water instead of sweetened beverages. 

Type 1 (formally Juvenile Diabetes)

  • Type 1
  • Symtoms
  • Diagnosis
  • Management

Type 1 diabetes is a chronic condition in which the pancreas produces little to no insulin. In type 1 diabetes, there’s no insulin to let glucose into the cells, so sugar builds up in your bloodstream. This can cause life-threatening complications. Different factors including genetics and some viruses, may contribute to type 1 diabetes.

Type 1 diabetes is caused by an autoimmune reaction (the body attacks itself by mistake) that destroys the cells in the pancreas that make insulin, called beta cells. It can take months or years for enough beta cells to be destroyed before symptoms of type 1 diabetes are noticed. Symptoms can develop in just a few weeks or months. Once symptoms appear, they can be severe. 

About 5% of the people with diabetes have type 1. Contrary to popular belief, type 1 diabetes is not a childhood disease. It occurs at every age. In fact, there are more adults who have type 1 diabetes than children. There is no known way to prevent type 1 diabetes. With the help of insulin therapy and other treatments, even young children can learn to manage their condition and live long, healthy lives.

Symptoms of Type 1 Diabetes

  • Increased thirst
  • Frequent urination
  • Bed-wetting in children who previously didn’t wet the bed during the night
  • Extreme hunger
  • Unintended weight loss
  • Irritability and other mood changes
  • Fatigue and weakness
  • Blurred vision
Consult your doctor if you notice any of the above signs and symptoms in you or your child. 

A simple blood test will let you know if you have diabetes. If you’ve gotten your blood sugar tested at a health fair or pharmacy, follow up at a clinic or doctor’s office to make sure the results are accurate.

If your doctor thinks you have type 1 diabetes, your blood may also test for autoantibodies (substances that indicate your body is attacking itself) that are often present with type 1 diabetes but not with type 2. You may have your urine tested for ketones (produced when your body burns fat for energy), which also indicate type 1 diabetes instead of type 2

The management of your diabetes relies on you with support from your health care team (your doctor, dentist, eye doctor, dietitian, pharmacist, specialist), family, and other important people in your life. Managing diabetes can be challenging, but there are many resource out there to help. 

If you have type 1 diabetes, you’ll need to take insulin shots (or wear an insulin pump) every day to manage your blood sugar levels and get your body the energy it needs. Insulin can’t be taken as a pill, because the acid in your stomach would destroy it before it gets in your bloodstream. Your doctor will work with you to figure out the right dosage of insulin for you. 

You will also need to check you blood sugar regularly. Ask your doctor about how often you should be checking it, when the best time to check is, and what your target blood sugar level should be. Keeping your blood sugar levels as close to target as possible will help you prevent or delay diabetes-related complications. 

If your child has type 1 diabetes, you’ll be involved in diabetes care on a daily basis, from serving healthy foods to giving insulin injections to watching for and treating hypoglycemia.

Hypoglycemia (low blood sugar) can quickly happen and needs to be treated immediately. It’s most often caused by too much insulin, waiting too long for a meal or snack, not eating enough, or getting extra physical activity. Hypoglycemia symptoms are different person to person, but can include:
  • Shakiness
  • Nervousness or anxiety
  • Sweating, chills, or clamminess
  • Irritability or impatience
  • Dizziness and difficulty concentrating
  • Hunger or nausea
  • Blurred vision
  • Weakness or fatigue
  • Anger, stubbornness, or sadness
If you have hypoglycemia several times a week, talk to your doctor to see if your treatment needs to be adjusted.

Gestational Diabetes

  • Gestational Diabetes
  • Risk Factors
  • Management/Treatment
  • After Delivery

Pregnant women who have never had diabetes before, but who have high blood glucose (sugar) levels during pregnancy, are said to have gestational diabetes. This usually happens around the 24th week of pregnancy. A diagnosis does not mean you had diabetes before you conceived, or that you will have diabetes after giving birth. According to the Centers for Disease Control and Prevention, about 9.2% of pregnant women develop gestational diabetes. 

It is unknown what causes gestational diabetes, but researchers have a few ideas. The placenta – which protects the baby as it grows – release hormones to help the baby develop. These hormones also block the action of the mother’s insulin in her body. This problem is called insulin resistance, and it makes it hard for the mother’s body to use insulin. It is possible that a soon-to-be-mom may need up to three times as much insulin. Without enough insulin, glucose cannot leave the blood and be changed into energy. The glucose builds up in the blood and causes hyperglycemia.

Gestational diabetes affects the mother in late pregnancy after the baby’s body has already formed, but still growing. Because of this, gestational diabetes does not cause the kinds of birth defects sometimes seen in babies whose mothers had diabetes before pregnancy.  However, if left untreated or poorly controlled gestational diabetes can hurt your baby. 

When you have gestational diabetes, your pancreas works overtime to produce enough insulin, but the insulin does not lower your blood sugar levels. Although insulin does not cross the placenta, sugar and other nutrients do.  Extra blood sugar goes through the placenta, giving the baby high blood sugar levels. This causes the baby’s pancreas to make extra insulin to the rid of the extra blood sugar. Since the baby is getting more energy than it needs to grow and develop, the extra energy is stored as fat. This extra fat can lead to macrosomia, or an overweight baby. 

If ultrasound images suggest your baby is larger than 10 pounds, your physician will likely recommend a cesarean section. Babies with macrosomia face health problems of their own, including damage to their shoulders during birth. Larger babies also have a three times higher risk of getting lodged in the birth canal (shoulder dystocia), which can be life-threatening. 

Because of the extra insulin made by the baby’s pancreas, newborns may have a very low glucose level at birth and are also at higher risk of breathing problems. Babies with excess insulin become children who are at risk for obesity and adults who are at risk for type 2 diabetes. Because of this, it is important to to talk with your doctor and start treatment as soon as possible. Treatment for gestational diabetes aims to keep blood glucose levels equal to those of pregnant women who don’t have gestational diabetes. This includes special meal plans and scheduled physical activity. It may also include daily blood glucose testing and insulin injections. 

  • Had gestational diabetes previously
  • Have given birth to a baby weighting more than 9 pounds
  • Are overweight
  • More than 25 years old
  • A family history of type 2 diabetes
  • Have Polycystic Ovary Syndrome (PCOS)

Keeping blood glucose levels under control will help ensure the health of the mother and baby. Lifestyle changes include:

  • Switching to a low-carb diet, under the guidance of a nutritionist
  • Reducing the number of calories consumed per day (for women who are overweight or obese)
  • A daily exercise routine as recommended by the health care provider
  • If diet and exercise aren’t enough, the provider might prescribe oral medication or insulin

Gestational diabetes typically resolves after the baby is born. Women need to be retested for diabetes at 6-12 weeks postpartum. Once blood glucose levels return to normal, women need to be screened for diabetes every 3 years because of the increased lifetime risk of developing type 2 diabetes.

Steroid-Induced Diabetes

  • Steroid-Induced Diabetes
  • Risk Factors
  • When to Call a Doctor

About 1 in every 10 hospitalized patients is treated with a steroid-containing drug such as hydrocortisone or prednisone. These drugs are used for reducing inflammation and suppressing the immune system, but they can also result in high blood glucose levels or, eventually, diabetes in those at high-risk. This type of diabetes typically goes away after the steroids are completed.

Patients who already have diabetes should be extremely cautious if a health care professional prescribes a steroid-containing medication. If this happens, be sure to ask your provider about increasing your diabetes medications to prevent a rise in blood glucose.

What to watch for if you are taking steroids
  • Urinating often
  • Feeling hungrier than usual
  • Excessive thirst
  • Feeling tired, even after a full night’s sleep
  • Infections that don’t seem to heal
Who’s At Risk
  • About half of all hospitalized patients who take high doses of steroids and have other risk factors for diabetes will develop high blood glucose levels.
  • Persons who already have diabetes often find it difficult to control their blood glucose when they take steroids.
  • Persons in the intensive care (ICU) are five times more likely to develop high blood glucose levels compared with other hospitalized patients.

Why you should notify your health care professional

  • Patients with normal blood glucose levels often have a shorter hospital stay, develop fewer infections, and heal more quickly than patients with uncontrolled or high blood glucose levels.
  • A history of steroid-induced diabetes usually indicates that presence of other risk factors for developing diabetes.

When to call you doctor

Make sure your health care provider knows as soon as you stop talking steroids or change that dose. It’s very important that the doctor adjusts your diabetes medications to prevent dangerous drops or rises in blood glucose. If your blood glucose level doesn’t return to normal after you stop taking steroids, notify your provider. 

Complications

Diabetes can affect every part of the body, including skin, feet, eyes, heart, nerves, and kidney. Long-term complications will develop over time. The longer you have diabetes – and the less controlled your blood sugar – the higher the risk of complications. These can include:
  • Cardiovascular disease – Diabetes dramatically increases your risk of various heart problems, including coronary artery disease with chest pain, heart attack, stroke, and narrowing of the arteries.
  • Nerve damage (neuropathy) – Excess sugar can injure the walls of the tiny blood vessels that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning, or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. If left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea, or constipation, 
  • Kidney damage (nephropathy) – The kidneys contain millions of tiny blood vessel cluster that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant. 
  • Eye damage (retinopathy) – Diabetes can damage the blood vessels of the retina, potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma. 
  • Foot damage – Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These inflections may ultimately require toe, foot, or leg amputation. 
  • Skin conditions – Diabetes may leave you more susceptible to skin problems including bacterial and fungal infections. 
  • Hearing impairment – Hearing problems are common in people with diabetes.
  • Alzheimer’s Disease – Type 2 diabetes may increase the risk of dementia, such as Alzheimer’s disease. The poorer your blood sugar control, the greater the risk appears to be. 
  • Depression – Symptoms of depression are common in people with type 1 or type 2 diabetes. Depression can affect diabetes management. 

Diabetes Heart Connection

Of people with diabetes, LESS THAN HALF are aware of their increased risk of cardiovascular disease. This lack of awareness prevent people with diabetes and their families from addressing risks and improving health.  The annual estimated medical cost and economic loss from premature death and disability caused by diabetes is $245 billion. More than 25% of cost of treating diabetes relates to cardiovascular complications. In Ohio, 1 in 7 adults – more than 1.3 million people – have diabetes. Diabetes prevalence in Ohio had more than doubled in the last 20 years.

Source: American Diabetes Association

Resources

Links to various resources on the topics discuss on this page. 

Internet Explorer is no longer supported. If you are experiencing issues, please try a different browser.