Let's Talk About Diabetes
Everything you ever wanted to know (and then some) on the causes, symptoms, and treatments of this chronic condition, and how to keep living your life, disease be damned.by Sunny Sea Gold Health Writer
Whether you’ve just been diagnosed or think you could have diabetes, you’re probably nervous, confused, and maybe even a little scared. That’s normal, and everyone featured on HealthCentral with a chronic illness felt just like you do now. But we—and they—are here for you. On this page alone, you’ll discover not only the realities and challenges of the condition, but also the best treatments, helpful lifestyle changes, wisdom from people who have been where you are now, and all the critical information to help you not just manage—but thrive. We’re sure you’ve got a lot of questions...and we’re here to answer them.
Our Pro Panel
We went to some of the nation's top experts in diabetes to bring you the most up-to-date information possible.
Katherine Araque, M.D.
Director of Endocrinology
Pacific Neuroscience Institute at Providence Saint John’s Health Center
Santa Monica, CA
Stelios Mantis, M.D.
Rush University Medical Center
Peter Goulden, M.D.
Medical Director of the Division of Endocrinology and Metabolism
Mount Sinai St. Luke's
New York, NY
About 23 million people in the United States have been diagnosed with diabetes. It’s estimated that another 7 million have it, but don’t know it yet. An additional 80 million Americans have prediabetes—higher-than-normal blood sugar that increases the risk of developing type 2 diabetes. Type 2 is the most common form of the disease: Between 90 and 95 percent of people with diabetes have it.
Yes, diabetes is a disease that causes people to have higher-than-normal levels of sugar (or glucose) in their blood. There are three main types: type 1, type 2, and gestational diabetes. Type 1 is mostly an autoimmune disease that stops the pancreas from producing insulin. In type 2, most people make enough insulin, but their bodies don’t use it well. Gestational diabetes only happens during pregnancy.
The disease is sneaky: It can have almost no visible symptoms. That’s why the U.S. Preventive Services Task Force recommends screening for adults over 40 who have risk factors such as abdominal obesity. Some signs to look out for include extreme thirst, blurry vision, and an increased need to pee.
The first step is a blood test, usually the A1C (or glycated hemoglobin) test which measures what percentage of your red blood cells have been coated with glucose over the past two to three months. The higher your blood sugar, the higher your score: A result below 5.7 is considered normal; 5.7 to 6.4 is prediabetic; 6.5 or above suggests diabetes.
What Is Diabetes, Anyway?
Everyone’s heard of diabetes. It’s one of the most common chronic diseases in the world and rates are still on the rise. Yet most people don’t fully understand what causes it or how it affects everyday life. Many think that because the disorder is so widespread, it isn’t serious. But if left untreated, diabetes can lead to heart disease, vision loss, and even limb amputation.
At its most basic, diabetes mellitus (the official name) is a group of disorders that cause people to have higher-than-normal levels of sugar—or, glucose—in their blood. Glucose comes from the protein, carbohydrates, and fats that you eat and drink, as well your liver, which makes and stores the substance.
If everything is going according to plan, your pancreas releases a hormone called insulin that helps move glucose from the bloodstream into some of the cells of your body to be used for energy. But if your body is resistant to insulin, or doesn’t make enough of it, the glucose gets stuck hanging out in your blood. That’s when your doc will tell you that you have “high blood sugar.” As time goes on, the extra sugar in your blood causes inflammation and other major health troubles.
About 30 million people in the United States have diabetes, but nearly one quarter of them don’t know it. Let’s take a closer look.
Most Common Types of Diabetes
There are several different types of diabetes and each has its own causes. It’s important to get an accurate diagnosis for which form of the disease you have because treatment will differ depending on type. Here are the basics you should know:
Type 1 Diabetes
Also called “juvenile” diabetes because it’s often diagnosed in childhood, type 1 diabetes is mostly an autoimmune disorder in which your immune system attacks and destroys insulin-making cells in the pancreas. Because of this, your body no longer produces its own insulin, so you need insulin injections every day.
Most people with type 1 diabetes are diagnosed during childhood or young adulthood, but a small number of people may not develop the disease until their 30s, 40s, or even 50s.
Type 2 Diabetes
People with type 2 do produce their own insulin, but their bodies don’t use very well. They are insulin-resistant.
Type 2, also called “adult-onset”, diabetes is the most common form of the disease. Between 90% to 95% percent of all people with diabetes have type 2. It usually develops in middle age but is sometimes seen in older kids or teens.
Most people with type 2 don’t need to take insulin, but they may need other medications to help bring down blood sugar.
If someone’s blood sugar is higher than normal, but not high enough to be diagnosed as diabetes, that’s considered prediabetes.
People with prediabetes have an increased risk of developing type 2. Exercise and diet changes are often prescribed to lower blood sugar and reduce the risk. In some cases, a doctor may also prescribe metformin, a blood-sugar lowering drug to help prevent type 2.
Gestational diabetes refers to temporary high blood sugar that happens only in pregnancy. Doctors suspect that it’s related to hormonal changes that happen during this time.
Most pregnant women are screened for gestational diabetes during their second trimester with a glucose tolerance test, which involves drinking a glucose-containing beverage on an empty stomach and then having blood drawn to check sugar levels.
Gestational diabetes is usually treated with exercise and diet changes (such as eating less starch and more veggies, fruits, and protein). Some women may need insulin injections, too.
Most of the time, blood sugar levels return to normal once the baby is born; but if you have gestational diabetes during pregnancy, you are also at higher than average risk for developing type 2 later in life.
Other Types of Diabetes
Though rare, these types of diabetes can cause serious health issues if left untreated:
Monogenic Diabetes: Accounting for 1% to 5% of all cases, this rare type of diabetes is caused by a mutation in a single gene. In most cases, the disease is due to a person’s pancreas not being able to make enough insulin; the condition is usually found in kids.
Secondary Diabetes: Sometime, diabetes is a side-effect of another disease, such as Cushing’s syndrome and cystic fibrosis. Certain medications, including niacin, diuretics, HIV medicines, and anti-seizure drugs, can also lead to high blood sugar.
What Causes Diabetes in the First Place?
The causes of the disease differ depending on what type you have.
Causes of Type 1
Type 1 diabetes is mostly an autoimmune disorder. In this case, your immune system attacks your body in the same way it might attack invaders like bacteria or viruses, destroying certain cells in your pancreas in a misguided attempt to protect the body. These cells, called beta cells, are the ones that produce insulin. When your body attacks and destroys them, you can no longer make your own insulin.
Doctors believe that type 1 diabetes may be caused by a combination of genes and environmental factors. Type 1 diabetes is treatable with daily insulin injections but isn’t curable; and lifestyle changes like diet and exercise won’t reverse it.
Causes of Type 2
Type 2 diabetes is usually caused by a combination of factors. It tends to run in families, and certain genes make you more likely to develop it. It’s also more common in some ethnic groups, including Native Americans, African Americans, Pacific Islanders, Asians, and Latinos.
How you eat and how active you are also important. Carrying extra body fat, especially in your belly, can contribute to insulin resistance, a situation where your pancreas makes plenty of insulin, but doesn’t use it well, so sugar builds up in your blood rather than going into your cells for energy. Insulin resistance is a major cause of type 2 diabetes.
Sometimes, type 2 diabetes is caused by an underactive pancreas and your body doesn’t make enough insulin.
Causes of Gestational Diabetes
Genetics and hormonal changes during pregnancy are the culprits of this type.
All women become insulin-resistant late in pregnancy, thanks to hormones released mostly by the placenta. Most of the time, the pancreas amps up production of insulin to make up the difference, but in cases where it can’t keep up, blood sugar levels rise and gestational diabetes develops.
Do I Have the Symptoms of Diabetes?
A tricky truth about this disease: Sometimes, there are no symptoms or symptoms are so mild that they’re easy to miss. That’s why nearly all pregnant women are screened for gestational diabetes, and the U.S. Preventive Services Task Force recommends screening for adults over 40 who have risk factors such as abdominal obesity.
Other times, symptoms are sudden and clear. Having any of the following signs does not necessarily mean you have diabetes. Instead, consider them a signal to call your doctor:
Major thirst: When your blood has too much sugar in it, your body pulls water from surrounding tissues to try to dilute it. That leaves you dehydrated and thirsty. Some diabetics feel like no matter how much they drink, they can’t quench their thirst.
A lot of pee: When there’s too much sugar in the blood, your kidneys try and filter it out. They dump it into your urine, creating more pee. In more advanced stages of the disease, damaged nerves around the bladder may cause some people to feel the urge to pee frequently, even if little or nothing comes out. You also have a higher risk of urinary tract infections (UTIs).
Blurry vision: High blood sugar can lead to a leaking of fluids into your eye, causing the lens to swell. That leads to trouble focusing.
The munchies: If you’re hungry all the time, even after a good meal, it could be a sign that your muscles and other tissues aren’t getting the energy—i.e. glucose—they need from the food you’re eating, because it’s hung up in your bloodstream. Your muscles tell your brain that they’re starving (even though you ate plenty), making you hungry again and continuing the cycle.
Increase in infections: Type 2 diabetes makes it harder for your immune system to fight off infections, including yeast infections or UTIs. It might also take longer for cuts to heal, because extra glucose prevents white blood cells from doing their repair work.
Weight loss: Losing weight without changing your diet could be a sign of type 1 diabetes. If your body can’t get the glucose it needs from food, it will start to break down its own fat, muscles, and other tissues for fuel, leading to weight loss.
Fatigue: You may feel exhausted and weak because your brain, muscles, and other body systems aren’t getting the energy they need to work properly. If you’re dehydrated, that can make you tired, too.
How Do Doctors Diagnose Diabetes?
The first step in getting a diabetes diagnosis is a blood test. Then, if you are diagnosed with diabetes, your doctor may perform additional testing to figure out which type you have. Correct diagnosis is important since treatment differs depending on type.
Blood Tests for Diabetes
A1C (or glycated hemoglobin) test. This common test measures what percentage of your red blood cells have been coated with glucose over the past two to three months. The higher your blood sugar, the higher your score. An A1C result below 5.7 is considered normal; 5.7 to 6.4 is prediabetic; 6.5 or above suggests diabetes.
Fasting blood sugar test. Blood will be drawn first thing in the morning before you eat or drink anything other than water. A result under 100 milligrams per deciliter is normal; 100 to 125 mg/dL is prediabetic; 126 mg/dL or above indicates diabetes. Your doctor will likely want to do the test twice before diagnosing you.
Glucose tolerance test. After getting your blood drawn on an empty stomach, you’ll drink a glucose drink, then have blood drawn again after one or two hours. If your blood sugar is under 140 mg/dL two hours after downing the sugar drink, that’s normal; 140 to 199 is prediabetic; 200 md/dL or over indicates diabetes.
Random blood sugar test. Blood is drawn at any time of day, whether you’ve eaten recently or not. A result of 200 mg/dL means you may have diabetes.
Antibody test. To help differentiate between type 1 and type 2 diabetes, your doctor may also draw blood for an “autoantibody” test, to see if your immune system is attacking your pancreas. People with type 1 often test positive for several specific autoantibodies, while those with type 2 (or the rare monogenic diabetes) won’t.
Urine Test for Diabetes
If your doctor suspects that you have type 1 diabetes, she may want to test your urine for ketones, chemicals your body produces when it breaks down fat for energy.
The test can be done at home or in a lab or doctor’s office by peeing into a specimen cup. Extremely high levels of ketones are a sign of ketoacidosis, a potentially fatal complication of diabetes that requires emergency treatment.
What Is the Best Treatment for Diabetes?
Whatever your path of treatment, most likely you’ll start by checking your glucose every day, or even several times per day, in order to make decisions about insulin dosages, food, and exercise.
To do this, you’ll likely use a home glucose meter to poke your fingertip with a specialized lancet “pen,” then drop the blood onto a test strip in the meter. In some cases, your doc might suggest a continuous glucose monitor, where a tiny sensor is inserted under the skin of your abdomen, arm, or thigh to check glucose levels regularly. The device will alert you if levels fall too low.
Here are a few types of treatments your doctor will consider, based on your diabetes type:
All people with type 1 diabetes need to take insulin daily. Some people with type 2 or gestational diabetes may need insulin as well. There are a couple of different ways insulin can be delivered to the body:
Injection: This is the most common way to take insulin. To inject the drug, you will use a syringe or “pen,” usually in your belly, upper arm, thigh, or butt.
Insulin Pump: People who need multiple injections per day or are high risk of ketoacidosis may prefer an insulin pump, which automatically delivers insulin throughout the day through a tiny catheter that’s worn on your body.
Insulin Inhaler: Some adults with type 1 or 2 diabetes can also use inhaled insulin, a powder you breathe into your lungs through an inhaler.
Several pills (or liquids), used in combination with each other or with insulin, can help lower blood sugar in people with type 2 diabetes. These are some of the common meds:
Actos and Avandia (thiazolidinediones) reduce circulating fat concentrations and improve sensitivity to insulin.
Amaryl, Glucotrol and Micronase (sulfonylureas), Prandin and Starlix (meglitinide), and Januvia and Onglyza (DPP-4 inhibitors), trigger the pancreas to produce more insulin.
Farxiga, Invokana, and Jardiance (SGLT2 inhibitors) boost the amount of sugar the kidneys can remove from your blood.
Glyset and Orecose (alpha-glucosidase inhibitors) slow the digestion and breakdown of starches into glucose and regulate how much glucose is absorbed by the small intestine.
Metformin (brands names Glucophage, Glumetza, Fortamet, and Riomet) slows the breakdown of carbohydrates you eat into sugar, and reduces how much glucose your liver produces.
Diet and Exercise
Eating well and exercising will help your health no matter what type of diabetes you have. That said, type 1 diabetes can’t be treated or cured through lifestyle changes. No matter how well you eat, you can’t make your pancreas be able to produce insulin again.
Diet can be used to help treat type 2 and gestational diabetes, though. One of the most important diet changes someone with type 2 can make is to reduce or cut out sugary drinks like soda and juices that may hike up blood sugar. Eating more low-starch vegetables and lean protein can help, too. Some people with diabetes may need to count the grams of carbohydrate they eat, since consuming a consistent amount at each meal helps balance blood sugar.
Regular exercise can also reduce insulin resistance and improve the way your body uses insulin, keeping type 2 diabetes in check.
Does Diabetes Treatment Cause Complications?
Any medication has potential side effects, and those for diabetes are no exception. But none are as serious as the alternative of not treating it—like heart disease, vision loss, nerve pain, foot ulcers, and even amputations.
These are some side effects for the most common diabetes treatments:
Continuous glucose monitoring: Skin irritation, pain, sore muscles.
Insulin: Low blood sugar, headaches, weight gain, flu-like symptoms. Infection of infusion site if using an insulin pump.
Oral medications: nausea, diarrhea, gas, sweating, feeling anxious or shaky, weight gain, swelling.
What's Life Like With Diabetes?
Look, it’s a disease—and living with it can be stressful. Some people don’t understand the condition and can’t grasp what you’re going through.
But because diabetes is relatively common, there are a lot of people who do understand and can help make life a little easier.
One of the biggest challenges can be the amount of so-called “self-management” you need to do—checking blood sugar, giving yourself injections, taking medications correctly, and sticking to a healthy diet.
For that reason, many people find working with a certified diabetes educator (CDE) useful. These healthcare providers (often registered nurses or registered dietitians) know the ins and outs of diabetes treatment and are able to come up with systems and solutions that work in real life.
If you find yourself feeling depressed and overwhelmed in the face of your diabetes diagnosis, don’t hesitate to tell your doctor. You are far from alone in feeling this way, and working with a diabetes educator, support group, or mental health counselor can get you back on track.
Where Can I Find Diabetes Communities?
Talking to people who know exactly what you’re going through can be just as important as finding a treatment plan that works. Here are some places to start to make connections, find resources, and meet friends.
Top Diabetes Instagrammers
There’s no shortage of ’grammers from the #T1D and #T2D communities — here’s a sprinkling of some of our faves who are sharing diabetes-friendly recipes and stigma-squashing real-talk.
Mila Clarke Buckley, @thehangrywoman
Follow because: She turns her lifestyle with diabetes (diagnosed with type 2 in 2016) into digital storytelling, sharing how to live with diabetes and still enjoy the finer things in life, like cheeseburgers and travel.
Michelle Laine, APRN-BC, @diabadassaprn
Follow because: This Yale University grad, family nurse practitioner, and Muay Thai kickboxing enthusiast is also a type 1 diabetes patient. Laine doesn’t sugarcoat (pardon the pun) her disease, but she does promise to never let it hold her back.
Carrie Lane, @officialcarrielane
Follow because: As a mama-to-be, Laine, who has type 1 diabetes, shares all about prepping to get pregnant, your ideal A1C levels during pregnancy, and how your body (and mind) change throughout. She’ll no doubt keep sharing through motherhood, so there’s no better time to go ahead and give her a follow.
Carl Franklin and Carrie Brown, @2ketodudes
Follow because: It’s no surprise to anyone that a lot of these 'grammers talk about food, because diabetes—especially type 2—is managed, in large part, with how you fuel your body. Their recipes range from gourmet eye candy to “hey, I can make that!”
Christel Oerum, @diabetesstrong_ig
Follow because: She turned a personal blog about exercise and nutrition for type 1 diabetes into one of the largest diabetes health websites, and created the ebook Fit With Diabetes to inspire anyone who is insulin-dependent.
Top Diabetes-Related Podcasts
2 Keto Dudes. This podcast follows Carrie Brown and her pal Carl Franklin on their journey from metabolic syndrome and type 2 diabetes to a cleaner and healthier life, which they credit to following a keto diet. Expect convos on the pros, cons, and controversies of keto.
Juicebox. Scott Benner is an author, blogger, and proud stay-at-home dad of a daughter with type 1 diabetes. Though he doesn’t have diabetes himself, he had to learn to manage diabetes as if it were his own, since his daughter was only 2 when she was diagnosed.
My Lazy Pancreas. Type 1 diabetes doesn’t have to hold you back from being an athlete. Kyle Masterman, whose goal is to cycle across Australia, brings on guests who are breaking barriers in sports and fitness—all while living with diabetes. Give it a listen on the way to the gym to help kick your butt into gear.
Diabetes Daily Grind. Amber Clour, who has lived with type 1 diabetes since childhood, brings together a team of people with type 1 or type 2 diabetes on this engaging podcast. The focus: Real advice about everyday life. No fluff, just reality.
Top Diabetes Support Groups and Non-Profits
American Diabetes Association. With more than 565,000 volunteers, 540,000 members, and 400 staff, this nonprofit is a force to be reckoned with. At the heart of their mission: Raising awareness about the impact of insulin prices and treatments for those with diabetes and advocating for policy changes.
Diabetes Research Institute Foundation. It starts here with the scientists who are working to find a cure for those living with diabetes. Their goal, a little unconventional, is to put themselves out of business. A cure means their work is done!
JDRF (Formerly called Juvenile Diabetes Research Foundation). This one’s for the kids — or, more often than not, parents of kiddos fighting type 1 diabetes. The nonprofit is the leading global organization funding type 1 diabetes research, having raised $2 billion for research to date.
Taking Control of Your Diabetes. The founder of this nonprofit is an endocrinologist who was diagnosed with type 1 diabetes at age 15. Steve Edelman, M.D., brings together patients and experts at conferences across the U.S. to help them better understand and manage their lives with diabetes.
DiabetesSisters. Hey ladies, welcome to the sisterhood. While diabetes does not discriminate, there’s a whole world of the disease that only affects women (hello pregnancy, menopause, and other hormone-imbalanced moments). Come here for peer support, education, and stories of hope.
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