Diabetes – Causes, Symptoms, Treatments

What is Diabetes?

Diabetes is a chronic condition that affects how your body regulates blood sugar.

Blood sugar, or glucose, is an important source of energy for your body. It comes from the food you eat and circulates in your bloodstream. Insulin, a hormone made by your pancreas, helps your body’s cells absorb glucose from the bloodstream.

With diabetes, either your body doesn’t produce enough insulin or your cells don’t respond to insulin as well as they should. This can lead to high blood sugar levels. Over time, high blood sugar can damage your nerves, eyes, kidneys, and heart.

Diabetes has become a global health concern with a staggering prevalence. Globally, over 422 million people worldwide have diabetes, according to the World Health Organization (WHO). This number has been steadily rising, particularly in low- and middle-income countries. Sadly, 1.5 million deaths are directly attributed to diabetes each year.

In the United States alone, an estimated 38.4 million people, or 11.6% of the population, had diabetes in 2021 according to the Centers for Disease Control and Prevention. Even more concerning is the number of undiagnosed cases, a staggering 8.7 million adults are estimated to have diabetes but aren’t aware of it.

While less common, 352,000 children and adolescents younger than 20 have diabetes in the US, with type 1 diabetes being the most prevalent form in this age group. The percentage of Americans with diabetes increases with age. Shockingly, 29.2% of adults 65 and older have diabetes.

Types of Diabetes

Diabetes, a chronic condition hindering blood sugar regulation, manifests in several forms. Each type presents unique characteristics and requires specific management strategies. Let’s delve deeper into the most common types:

1. Type 1 Diabetes (T1D):
   • Cause: An autoimmune disease where the body’s immune system mistakenly attacks insulin-producing beta cells in the pancreas. This results in little to no insulin production.
   • Onset: Often diagnosed in childhood or young adulthood, though it can develop at any age.
   • Symptoms: Excessive thirst, frequent urination, unintended weight loss, fatigue, blurred vision.
   • Management: Requires lifelong insulin therapy to replace the missing insulin and manage blood sugar levels. This can involve multiple daily injections or continuous glucose monitoring (CGM) systems with pumps for more precise control. Maintaining a healthy diet, regular exercise, and self-monitoring of blood sugar are also crucial.
2. Type 2 Diabetes (T2D):
   • Cause: Characterized by insulin resistance, where the body’s cells become less responsive to insulin, or insulin deficiency, where the body doesn’t produce enough insulin. Several factors contribute to T2D, including genetics, lifestyle choices like unhealthy diet and physical inactivity, and being overweight or obese.
   • Onset: Usually develops in adulthood, but the increasing prevalence of childhood obesity has led to earlier diagnoses in some children.
   • Symptoms: Often go unnoticed in the early stages. Symptoms similar to T1D may appear when blood sugar levels become significantly elevated.
   • Management: Can sometimes be controlled with lifestyle modifications like healthy eating, regular exercise, and weight management. In some cases, oral medications or injectable medications may be necessary to help regulate blood sugar. Similar to T1D, self-monitoring of blood sugar is essential.
3. Gestational Diabetes (GD):
   • Cause: Develops during pregnancy due to hormonal changes that can impair insulin’s ability to function effectively. It usually resolves after childbirth, but women with GD have a higher risk of developing T2D later in life.
   • Onset: Diagnosed during pregnancy, typically in the second or third trimester.
   • Symptoms: There are usually no noticeable symptoms. Gestational diabetes is typically identified through prenatal screening tests.
   • Management: Often controlled with diet and exercise. In some cases, medication may be necessary to ensure healthy blood sugar levels for both mother and baby. Monitoring blood sugar levels is crucial throughout pregnancy.
4. Prediabetes:
   • Cause: A warning sign indicating blood sugar levels are higher than normal but not high enough for a diabetes diagnosis. If left unchecked, it can progress to T2D.
   • Symptoms: No specific symptoms, but some people may experience fatigue or increased thirst.
   • Management: Lifestyle changes like healthy eating, weight management, and regular physical activity can significantly decrease the risk of developing T2D.

What are the risk factors of Diabetes?

Excess weight, especially around the abdomen, is a significant risk factor for type 2 diabetes. Fat cells, particularly visceral fat, release hormones and other substances that can lead to insulin resistance and inflammation. Lack of regular physical activity can contribute to obesity and increase the risk of type 2 diabetes. Exercise helps control weight, uses up glucose as energy, and makes cells more sensitive to insulin.

A diet high in processed foods, refined carbohydrates, sugars, and saturated fats can increase the risk of type 2 diabetes. On the other hand, a diet rich in whole grains, fruits, vegetables, and lean proteins can lower the risk.

Having a close relative with type 2 diabetes increases the likelihood of developing the condition. Genetic factors play a role in determining susceptibility to diabetes. The risk of type 2 diabetes also increases with age, especially after the age of 45. This is partly because people tend to exercise less, lose muscle mass, and gain weight as they get older. Certain ethnic groups, such as African Americans, Hispanic/Latino Americans, Native Americans, Asian Americans, and Pacific Islanders, have a higher risk of developing type 2 diabetes compared to Caucasians.

Women who develop gestational diabetes during pregnancy are at higher risk of developing type 2 diabetes later in life, as are their children. Additionally, women with PCOS have a higher risk of insulin resistance and type 2 diabetes due to hormonal imbalances.

Hypertension is often associated with insulin resistance and can increase the risk of type 2 diabetes. High levels of low-density lipoprotein (LDL) cholesterol and triglycerides, and low levels of high-density lipoprotein (HDL) cholesterol, can increase the risk of type 2 diabetes and heart disease.

Smoking increases the risk of type 2 diabetes and complications related to the condition. It can also make it harder to control diabetes and its complications. Poor sleep quality, sleep apnea, and other sleep disorders have been linked to an increased risk of type 2 diabetes. Lack of sleep can affect hormones that regulate glucose metabolism and appetite.

Complications of Diabetes

Diabetes, if not effectively managed, can lead to a range of serious complications affecting various parts of the body. Diabetes significantly increases the risk of heart disease, stroke, and other cardiovascular conditions. High blood sugar levels can damage blood vessels and nerves that control the heart and blood vessels, leading to atherosclerosis (hardening and narrowing of arteries), heart attacks, and strokes.

Prolonged high blood sugar levels can damage nerves throughout the body, causing tingling, numbness, burning sensations, or pain. This can affect various organs and parts of the body, leading to complications such as diabetic peripheral neuropathy, autonomic neuropathy (affecting involuntary functions like digestion and heart rate), and mononeuropathy (affecting a single nerve).

This disease is a leading cause of kidney failure (end-stage renal disease). High blood sugar levels over time can damage the small blood vessels and filtering units in the kidneys, impairing their function and leading to chronic kidney disease.

Diabetes can cause damage to the blood vessels in the retina, the light-sensitive tissue at the back of the eye. This can lead to diabetic retinopathy, which may cause vision impairment or blindness if left untreated.

Poor circulation and nerve damage in the feet are another long term complication of the non communicable disease. Diabetes increases the risk of foot ulcers, infections, and, in severe cases, requires amputation of the impacted limb. Peripheral artery disease (PAD) is also more common in people with diabetes, further increasing the risk of foot complications.

Various skin problems also have an increased risk of occurrence for those diagnosed with diabetes, including bacterial and fungal infections, itching, and slow wound healing. High blood sugar levels create an environment conducive to bacterial and fungal growth and impair the immune system’s ability to fight infections.

Diabetes increases the risk of gum disease (periodontal disease), which can lead to gum inflammation, tooth loss, and other oral health problems.

It is also associated with an increased risk of depression, anxiety, and other mental health disorders. Managing a chronic condition like diabetes can be challenging and may contribute to psychological distress.

Diabetes can lead to sexual problems in both men and women, including erectile dysfunction in men and reduced sexual arousal and lubrication in women. Uncontrolled diabetes during pregnancy (gestational diabetes) can increase the risk of complications for both the mother and the baby, including preeclampsia, miscarriage, preterm birth, and birth defects.

How is Diabetes Diagnosed?

Diabetes is diagnosed through various blood tests that measure blood sugar levels. The Fasting Plasma Glucose (FPG) Test measures blood sugar levels after an overnight fast (typically for at least 8 hours). A fasting plasma glucose level of 126 milligrams per deciliter (mg/dL) or higher on two separate occasions indicates diabetes.

The Oral Glucose Tolerance Test (OGTT) involves fasting overnight and then drinking a sugary solution. Blood sugar levels are measured before drinking the solution and again 2 hours after. A blood sugar level of 200 mg/dL or higher 2 hours after drinking the solution indicates diabetes.

Hemoglobin A1c (HbA1c) Test is used to measure the average blood sugar level over the past 2 to 3 months by assessing the percentage of hemoglobin that is glycated (sugar-coated). When glucose (sugar) is present in the bloodstream, it can attach to hemoglobin, a protein found in red blood cells that carries oxygen throughout the body. This process, known as glycation, occurs continuously as long as blood sugar levels are elevated. An HbA1c level of 6.5% or higher is indicative of diabetes.

The Random Plasma Glucose Test measures blood sugar levels at any time of the day, regardless of when the person last ate. A random plasma glucose level of 200 mg/dL or higher, along with symptoms of diabetes such as increased thirst and urination, indicates diabetes.

If initial test results indicate diabetes, healthcare providers may repeat the tests on a different day to confirm the diagnosis and rule out any temporary fluctuations in blood sugar levels. Additionally, they may perform further tests to classify the type of diabetes and assess for any complications or comorbidities.

How is Diabetes Treated? 

The treatment options for diabetes depend on the type of diabetes, individual health factors, and treatment goals. Lifestyle changes are often the first-line treatment for diabetes and can be beneficial for both type 1 and type 2 diabetes. These include healthy eating. Following a balanced diet that controls carbohydrate intake, emphasizes whole foods, fruits, vegetables, lean proteins, and healthy fats, and limits sugary and processed foods.

Engaging in regular exercise, such as brisk walking, cycling, swimming, or strength training, helps lower blood sugar levels, improve insulin sensitivity, and promote overall health. Achieving and maintaining a healthy weight can improve blood sugar control and reduce the risk of complications. Weight loss, if necessary, can be achieved through a combination of diet and exercise.

Medications may be prescribed to help lower blood sugar levels and improve insulin sensitivity. For type 2 diabetes, oral medications such as metformin, sulfonylureas, meglitinides, DPP-4 inhibitors, SGLT2 inhibitors, and thiazolidinediones are commonly prescribed to lower blood sugar levels by various mechanisms.

For people with type 1 diabetes and some with type 2 diabetes, insulin therapy may be necessary to replace or supplement the body’s insulin production. Insulin can be administered via injections, insulin pens, or insulin pumps. GLP-1 receptor agonists and amylin analogs are injectable medications that can help lower blood sugar levels, promote weight loss, and reduce the risk of cardiovascular complications.

Regular monitoring of blood sugar levels using a glucometer or continuous glucose monitoring (CGM) system helps individuals track their progress, make informed treatment decisions, and adjust their lifestyle and medication as needed. Regular visits to healthcare providers are essential for monitoring blood sugar levels, assessing overall health, adjusting treatment plans as needed, and screening for complications such as eye, kidney, nerve, and cardiovascular problems.

Diabetes education programs provide information about diabetes management, self-care practices, nutrition, physical activity, medication, and coping strategies. Support from healthcare providers, diabetes educators, support groups, and loved ones can also be invaluable in managing diabetes effectively.

In certain cases, surgical procedures such as bariatric surgery may be recommended for individuals with severe obesity and type 2 diabetes who have not achieved adequate blood sugar control with other treatments. Bariatric surgery can lead to significant weight loss and improvement in diabetes symptoms and may even result in remission of diabetes in some cases.

What medications are most often prescribed for Diabetes?

Several medications are commonly prescribed for the management of diabetes, particularly for type 2 diabetes. The choice of diabetes medication depends on various factors, including the individual’s health status, blood sugar levels, presence of other medical conditions, and treatment goals. 

• Metformin: Metformin is often the first-line medication for type 2 diabetes. It belongs to the class of drugs known as biguanides and works by reducing the amount of glucose produced by the liver and improving insulin sensitivity in muscle cells. Metformin may also help with weight loss and has a low risk of hypoglycemia.
• Sulfonylureas: Sulfonylureas are a class of oral medications that stimulate insulin secretion from the pancreas, thereby lowering blood sugar levels. Examples include glyburide, glipizide, and glimepiride. Sulfonylureas may increase the risk of hypoglycemia and weight gain.
• Dipeptidyl peptidase-4 (DPP-4) inhibitors: DPP-4 inhibitors work by blocking the enzyme DPP-4, which increases the activity of incretin hormones that stimulate insulin release and decrease glucagon secretion. Examples include sitagliptin, saxagliptin, linagliptin, and alogliptin.
• SGLT2 inhibitors: Sodium-glucose cotransporter-2 (SGLT2) inhibitors work by blocking the reabsorption of glucose by the kidneys, leading to increased glucose excretion in the urine and lower blood sugar levels. Examples include canagliflozin, dapagliflozin, and empagliflozin. SGLT2 inhibitors may also reduce the risk of cardiovascular events and kidney disease progression.
• Thiazolidinediones (TZDs): TZDs, also known as glitazones, improve insulin sensitivity in peripheral tissues such as muscle and fat cells. Examples include pioglitazone and rosiglitazone. TZDs may increase the risk of fluid retention, weight gain, and fractures.
• GLP-1 receptor agonists: Glucagon-like peptide-1 (GLP-1) receptor agonists mimic the action of incretin hormones, stimulating insulin release, suppressing glucagon secretion, delaying gastric emptying, and promoting satiety. Examples include exenatide, liraglutide, dulaglutide, semaglutide, and lixisenatide. GLP-1 receptor agonists may also promote weight loss and reduce cardiovascular risk.
• Insulin: Insulin therapy is essential for people with type 1 diabetes and may be necessary for individuals with type 2 diabetes who cannot achieve adequate blood sugar control with oral medications alone. Insulin is available in various formulations, including rapid-acting, short-acting, intermediate-acting, and long-acting insulin analogs. Insulin may be administered via injections or insulin pumps.