Understanding Diabetes: Types, Symptoms, Course, and Treatment

Diabetes is a prevalent chronic disease. According to the 2022 National Diabetes Statistics Report, 37.3 million people have diabetes, 28.7 of which have received a diagnosis, and 8.5 million of whom do not know they have it. This total is 11.3% of the U.S. population.

Key takeaways:
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    Diabetes is a very common disease without a cure.
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    There are several types of diabetes: Type 1, Type 2, Gestational, and others which contain forms such as Monogenic. And there are several different laboratory tests to detect diabetes.
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    The treatment of diabetes includes Healthy eating, Being active, Monitoring, Taking medication, Problem solving, Healthy Coping and Reducing risks.
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    The course of diabetes may include lifestyle changes, medication, and insulin. Taking an active role in your diabetes treatment plan can ensure you are following a program that fits your lifestyle, is manageable for you, and will yield results you are satisfied with.

Prediabetes can be a precursor to diabetes, but fortunately, making lifestyle changes can help. The total number of people 18 years of age and older with prediabetes is 96 million, or 38% of the U.S. population. A significant number of those, 26.4 million, are 65 years of age and over.

Types of Diabetes

  • Type 1: The body does not make enough insulin. The immune system attacks the cells in the pancreas called beta cells. This type of diabetes is typical in young adults and children. People with type 1 require insulin injections.
  • Type 2: The body does not make or use insulin well. This type of diabetes occurs mostly in middle-aged to older adults but can occur in childhood. Lifestyle changes or oral medications can often help.
  • Gestational: It can develop in a woman when she is pregnant. It often goes away after giving birth but is a risk factor for developing diabetes later in life.
  • Other types: Less common forms include monogenic diabetes, caused by a change in a single gene in the body. Multiple genetic mutations may cause these forms of diabetes.

Diabetes develops when the body can’t make enough insulin, the body is resistant to using the insulin, or both. 90 to 95 % of people have type 2 diabetes.

Diabetes symptoms

Type 2 diabetes can take several years to develop. Symptoms for type 1 and type 2 diabetes may be hard to spot and include:

  • Excessive urination
  • Excessive thirst
  • Excessive hunger
  • Weight loss without trying
  • Blurry vision
  • Tingling and numbness in feet and hands
  • Fatigue
  • Dry skin
  • Wounds that heal slowly
  • More infections than usual

In addition, type 1 diabetes may also have nausea, vomiting, or stomach pains. Gestational diabetes has no symptoms.

Diagnosing Diabetes

Doctors can perform several tests to diagnose diabetes and monitor its progression. This is done by testing blood sugar or blood glucose levels. Each test has a specific process and an expected result.

Laboratory tests for diabetes

TestDescriptionNormal Range
Fasting plasma glucoseFasting is required for 8 hours prior to the test except for water70 mg/dL – 100 mg/dL
2-hour oral glucose tolerance testRequires consumption of a liquid having 75 grams of glucose, no eating or drinking for 8 hoursLower than 140 mg/dL
Random plasma glucoseTaken any time of the dayLower than 140 mg/dL
Hemoglobin A1CDoes not require fasting and allows drinking.Below 5.7%

Blood glucose is expressed in mg/dL. Any number under 70 is considered an acute complication called hypoglycemia or low blood glucose, which can have dire consequences if left untreated.

Unlike the other tests, the Hemoglobin A1C measures average blood glucose levels over the past 3 months.

Treatment of Diabetes

The American Association of Diabetes Care and Education Specialists (ADCES) formed a framework for diabetes self-care to support informed decision making by the person with diabetes and improve glucose control, health outcomes, and quality of life.

Included below are the ADCES7 Self-Care Behaviors and their application to the person with diabetes.

  • Healthy eating – use a personalized meal plan, plan strategies (carb counting, exchanges, plate method, mindful eating), establish healthy eating patterns, measure portions, and monitor intake, understand, and use nutritional facts label, shopping, and eating away from home
  • Being active – engage in exercise and physical activity (housework, recreation, and sports count), sources for exercise/physical activity, follow safety precautions including obtaining medical clearance, wear appropriate shoes, ways to monitor progress
  • Monitoring – use a blood glucose monitor or continuous glucose monitor and monitor “time in range” glucose values. use a blood pressure monitor, track amount of time spent in physical activity or steps, determine amount of carb consumed or meal size, measure weight, track hours of sleep
  • Taking medication – understand medication (name, dose, frequency, optimal timing, adverse effects, action for missed dose); keep a current, accurate medication list and history; identify track, and take medication via vial or pen as prescribed at the right time, use alternate insulin delivery systems such as an insulin inhaler or insulin pump
  • Problem solving – manages changes in diabetes throughout the life cycle and as it progresses, manages the complexities and challenges of diabetes
  • Healthy coping – use stress reduction techniques (progressive muscle relaxation , meditation, guided imagery, deep breathing) and locating resources, develop support system
  • Reducing risks – maintain personal care records, keep track of medical appointments for regular eye, foot, and dental examinations, smoking cessation, perform skin and foot exam, monitor symptoms or changes in health, use of health apps and web portals, manage low or high blood glucose, develop a sick day plan

Course of Diabetes

Lifestyle changes such as weight loss, proper diet, and exercise can help those diagnosed with diabetes manage it. Although there is no cure, many people with type 2 diabetes can go into remission. Some may use oral medication or injectable medication. Depending on your physicians’ approach, you may try up to 3 medications before moving to insulin. People with type 1 diabetes benefit from lifestyle changes but rely on insulin up to 4 times per day.

Lifestyle changes for remission include a diet with a specific number of carbohydrate portions. Replacing refined carbohydrates with whole grain food, increasing the intake of vegetables and other foods high in dietary fiber, and reducing the amount of saturated fat in the diet is key to a healthy lifestyle. This is not a diabetic diet, but rather healthy eating changes that everyone should adopt. A person with diabetes can even include a piece of cake in their meal if it is considered part of the carbohydrates they are consuming.

Exercise can include going to the gym to work on a treadmill, or it can consist of moderate physical activities like vacuuming the floor and walking. Moderate physical activity can also be leisure activities, such as ballroom dancing or walking the course when golfing and carrying your clubs.

Medications

Most medications come in oral form; some are injectable. They all work differently to normalize blood glucose levels.

The goals of medication are to:

  • Decrease how much glucose your liver makes, and help your muscles absorb insulin. The most commonly used is Metformin.
  • Decrease your appetite. Some common names are Trulicity and Byetta.
  • Make your pancreas release insulin. Prandin and Starlix are both in this category.
  • Excrete glucose through your urine. Some common names are Invokana and Jardiance.
  • Stimulate the pancreas to make more insulin. These are the oldest generation drugs including Glucotrol and Micronase.
  • Help your fat cells use insulin better. Common names include Avandia and Actos.

Finally, there is insulin, a hormone that your pancreas makes. It allows cells to use glucose. If your body doesn’t make or use insulin properly, you can take manufactured insulin. Insulins vary according to when they start to work when their peak action is and how long they last in your system. Insulin use varies by type of insulin and frequency of use. These are determined by your diabetes care physician.

The five types of insulin are:

  • Rapid-acting insulin
  • Short-acting insulin
  • Intermediate-acting insulin
  • Mixed insulin
  • Long-acting insulin
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