By Tom Iarocci, MD. May 7th 2016

If the diagnosis of diabetes is already impacting your life, take heart in knowing this is one disease for which resources can be found in abundance.

Diabetes, also referred to as diabetes mellitus, can affect both men and women at any age. Even children can develop diabetes. There are two basic types of diabetes: type 1 and type 2. We tend to hear about type 2 diabetes the most. It develops gradually, there is a strong link to obesity, and it tends to affect older adults as a result of diet, lifestyle and genetics.

Without treatment, a person with diabetes will have abnormally high levels of glucose (blood sugar), especially after eating starchy foods like rice, potatoes, and bread, not to mention sweets. In the short term, such as when first being diagnosed with diabetes, high blood glucose levels can cause you to experience blurry vision, thirst, exhaustion, and hunger. You might have weight gain, weight loss, or a frequent and overwhelming urge to urinate. Over the long term, high glucose levels, if not controlled, can be much more sinister.

By comparison, type 1 diabetes is not as common, can affect people of all ages, and many people develop their first symptoms as children or young adults. You might need to make dietary changes with type 1, but this form of diabetes is typically not caused by diet; rather, the condition occurs because of genetics, and possibly a combination of genes and the environment. You can’t use diet and exercise to help avoid type 1 diabetes, but many people can and do ward off type 2 diabetes through diet and exercise.

Type 1 and type 2 diabetes

If you’re ever in doubt about which type of diabetes someone is talking about, you can guess type 2, and you’ll be right most of the time. But that’s not to diminish the importance of type 1, which is still the most common type of diabetes in childhood. Both forms of diabetes result in high blood sugar.

Type 1 diabetes

In type 1 diabetes, the pancreas loses its ability to produce insulin, and that is the main problem. The cells in the pancreas that make insulin are destroyed by the immune system in type 1. No one knows for sure why this happens, but genes and viruses are thought to be involved.

Type 2 diabetes

With type 2 diabetes, the main problem starts not with the pancreas (and its ability to make insulin), but with the body’s cells and their response to insulin. In type 2 diabetes, fat, liver, muscle, and other cells begin to ignore insulin, even though it’s plentiful and circulating in the blood stream. As a result, over time, the pancreas produces more and more insulin, while the body’s cells respond less and less to the insulin (insulin resistance), and sugar builds up in the blood stream -- because insulin is what helps sugar get transported into your cells.

Symptoms and warning signs of diabetes

The symptoms of diabetes come from having too much glucose in your blood. Since type 2 diabetes is so gradual, and screening practices have become more advanced over the years, most people nowadays find out they have type 2 diabetes from a blood test, rather than because of symptoms. In contrast, since type 1 diabetes tends to happen in a flash, relatively speaking, glucose begins to surge without much notice, and symptoms tend to be more prominent.

Most common presenting symptoms of both type 1 and type 2 diabetes are due to the high glucose levels and include:

  • Frequent urination
  • Increased thirst
  • Increased fluid intake

Other symptoms include:

  • Blurred vision
  • Feelings of irritability
  • Severe fatigue
  • Unexpected weight loss
  • Feelings of extreme hunger
  • Irritation of the skin in the genital area
  • Slower healing of superficial wounds

Weight loss tends to be seen most commonly with Type 1 diabetes, and children who develop type 1 diabetes often appear slightly ill and have a history of weight loss, tiredness, and frequent thirst and urination. A serious condition known as diabetic ketoacidosis, or DKA, can occur in people with these symptoms.

Causes and risk factors

The exact cause of diabetes is unclear, but several risk factors are evident, especially in type 2 diabetes. In type 1 diabetes, scientists can’t point to anything that can be done in the way of prevention, but with type 2, the risk factors are better known, and many of them can be changed.

Genes play a role, and if a parent has diabetes, you are much more likely to develop it yourself. Pregnancy is also a risk factor for type 2 diabetes, as is being over the age of 45. You’re also at risk for type 2 if you are overweight, don’t exercise, smoke cigarettes, don’t get enough sleep, or have a poor diet. People who eat a lot of red meat, high fat dairy products, and sweets – even if they aren’t overweight – may be at higher risk than those who eat more fruits and vegetables, fish, chicken, and whole grains.

Obesity is the strongest risk factor for type 2 diabetes, and this is especially true when the extra weight is distributed around the waistline. Scientists believe the fat cells send chemical signals throughout the body to tell the other cells it’s ok not to respond forcefully when insulin comes knocking at the door. As a result, glucose stays outside the cells, in the bloodstream, and levels rise.

What about family history as a risk factor? Well, you can imagine a family might be at increased risk if, for instance, they are a big fried food family. Or maybe diabetes runs in the family despite eating healthy, because of genes. But while genes and diet can explain a lot, researchers say they don’t fully explain all the extra risk of having diabetes in your family tree. Something else is also at work that hasn’t yet been discovered.

Prevention and treatment

Many people can prevent type 2 diabetes by eating a healthy diet and by maintaining a regular exercise routine. But if you can’t prevent diabetes, then you have to control your blood sugar.

Patients with type 1 diabetes will need insulin injections. Patients with type 2 diabetes can often control their glucose with oral medications alone, but some will need insulin as the disease progresses. Control is crucial to avoid the silent, sinister effects of years of high blood glucose. Poor control is linked to diseases of the eyes, kidneys, heart, arteries, and the smallest of blood vessels throughout your body. The list of potential complications from diabetes can be daunting, but it’s encouraging to know that you can prevent many of them by controlling blood sugar.

In addition to glucose control, screening and treatment may be needed for complications including heart problems, kidney disease, eye disease (diabetic retinopathy), and other conditions such as diabetic foot ulcers, infections, and neuropathy.

Treatment and prevention depends on individual factors like disease severity, diet, and lifestyle. Even if you exercise and maintain a balanced diet, you may need to take medications to treat your type 2 diabetes. If you have diabetes or a family history of diabetes, it is important that you remain under the care of your doctor.

Many countries have a national diabetes association available to help patients and professionals find resources. In the United States, the American Diabetes Association (ADA) provides information about food, fitness, and living with diabetes.

Tests and diagnosis

With type 1 diabetes, often a child or a young adult will have symptoms and a history that strongly suggests diabetes, and the test results make the diagnosis official. With type 2 diabetes, this is not often the case, and early detection is very important.

Blood tests are used both to screen for and diagnose diabetes. These tests include an A1C (hemoglobin A1C), FPG (fasting plasma glucose), or a 2-h OGTT (two-hour oral glucose tolerance test).

According to ADA recommendations, testing for diabetes or prediabetes should be done in all overweight adults (BMI ≥25 kg/m2) who have one or more additional risk factors for diabetes (for instance, family history of diabetes), and all people regardless of risk factors after age 45. If screening tests are negative, you don’t need to be tested for another 3 years.

Take the next steps

New cases of type 1 diabetes impact thousands every year, and type 2 diabetes and its prevention is becoming a fact of life. Its important to know the basics, even if nobody you know has diabetes yet. Whether you are interested in prevention for yourself or for someone you care for, your interest is likely to pay off in a big way. Early detection and good control of blood glucose is key.

If the diagnosis of diabetes is already impacting your life, take heart in knowing this is one disease for which resources can be found in abundance. Learn more about how you can track your condition and how you can work with your doctor to help keep diabetes in check and complications out of the picture.

Consider making use of the online community. If a diagnosis is new to you, or even if you’ve had diabetes for years, sometimes it helps just to connect with other people who’ve lived with diabetes, to get new tips or share tips of your own.

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