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Diabetes

Diabetes is a disease where blood sugar levels are too high because the body can no longer make or use insulin properly. The condition could lead to serious complications and even death. An estimated 34.2 million Americans have diabetes, according to the Centers for Disease Control and Prevention.

Last Modified: November 1, 2022
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What Is Diabetes?

Diabetes is a chronic disease that affects blood sugar control. When we eat, blood sugars go up. An organ called the pancreas releases the hormone insulin to allow cells to access glucose/blood sugar for energy. Insulin brings blood sugars down after a meal.

People with diabetes don’t produce enough insulin or their bodies can’t use insulin properly. In Type 1 diabetes, an autoimmune disease, the pancreas stops making insulin. However, in Type 2 diabetes, the body’s cells become resistant to insulin. Most people with Type 2 diabetes make insulin, but their cells don’t respond to it. As a result, blood sugars stay high.

Excess blood sugar in uncontrolled diabetes can lead to other health problems such as kidney damage, stroke, vision loss and heart disease. Diabetes is also the number one cause of lower limb amputations.

Diabetes Statistics and Facts

According to recent diabetes statistics, diabetes is on the rise in children but declining in adults. Researchers link this shift to growing obesity rates in young people.

Key Diabetes Statistics
  • 37.3 million American adults have been diagnosed with diabetes.
  • One in 5 American adults doesn’t know they have diabetes.
  • Diabetes is the seventh leading cause of death in the U.S.

Diabetes risk goes up with age. Rates of diagnosed diabetes are higher in adults ages 45 to 64 and those older than 65.

People with prediabetes have higher than normal blood sugar levels, but the levels are not high enough for a Type 2 diabetes diagnosis. According to the Centers for Disease Control and Prevention, about 96 million U.S. adults have prediabetes.

Prediabetes can progress to Type 2 diabetes and it increases the risk of stroke and heart disease. Most people with prediabetes can prevent a Type 2 diabetes diagnosis with lifestyle changes such as losing weight and exercising more.



Types of Diabetes

There are three types of diabetes: Type 1, Type 2 and gestational diabetes. Each type affects the body’s production and use of insulin, but each has a different cause. Type 1 is an autoimmune disease, Type 2 is lifestyle-related (and the most common type) and gestational diabetes occurs during pregnancy.

Type 1 Diabetes

Researchers think an autoimmune response causes Type 1 diabetes. The immune system attacks the pancreas and stops the body from making insulin. Only about 10% of people with diabetes have Type 1. Without daily doses of insulin, people with Type 1 diabetes can’t survive.

Doctors typically diagnose Type 1 diabetes in children and young adults. The symptoms of Type 1 develop quickly. They include unexpected weight loss, frequent urination, feeling tired and having blurry vision.

What is Type 2 Diabetes
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Type 2 Diabetes

Type 2 diabetes is the most common type, affecting 90% to 95% of people with diabetes. Those with Type 2 diabetes have high blood sugars because they don’t respond to insulin’s effects.

Picture insulin as the key that unlocks the door to cells so they can access sugar for energy. In Type 2 diabetes, the lock becomes rusty and doesn’t work as well. Therefore, sugar remains in the bloodstream instead of entering the cells, causing damage throughout the body.

Gestational Diabetes

Gestational diabetes occurs in women during pregnancy and goes away after giving birth. Gestational diabetes increases a mother’s risk of pregnancy complications and Type 2 diabetes later in life (for mother and child).

What Are the Symptoms of Diabetes?

Blood sugar imbalances lead to diabetes symptoms. They include weakness or fatigue, vision problems, increased hunger, sudden weight loss or weight gain, frequent urination and increased thirst.

Type 1 diabetes symptoms are more severe and rapid than the gradual onset of Type 2 diabetes. Annual checkups and bloodwork can help prevent Type 2 diabetes from going undetected.

Nutritionist Rebecca Montrone discusses symptoms her patients with Type 2 diabetes have described.

Diabetes Risk Factors

Researchers don’t know the exact cause of Type 1 diabetes. There may be some common genetic factors linking them, but a substantial link between the two conditions has not been determined. While they both involve hyperglycemia, they’re two very distinct diseases with their individual causes and risk factors.

Key Risk Factors for Diabetes
  • Type 1: Researchers believe family history and early childhood infections may increase the risk of developing Type 1 diabetes. In the U.S., African Americans, Hispanic and Latino people are less likely to develop Type 1 than those who are white.
  • Type 2: People with a family history of diabetes or excess body weight are more likely to develop Type 2. You’re also at higher risk if you’re older than 45 or have a history of prediabetes or gestational diabetes. African Americans, Hispanic or Latino people, American Indians, Alaska Natives, Pacific Islanders and Asians are more likely to develop Type 2 diabetes.
  • Gestational: Being older than 25, having a previous case of gestational diabetes, having polycystic ovary syndrome or a family history of gestational diabetes all increase your risk. Maternal weight before and during pregnancy can also play a role in a higher risk of gestational diabetes.

Lifestyle changes can decrease your risk of Type 2 and gestational diabetes. These include quitting smoking, avoiding heavy alcohol consumption, exercising at least three times a week and maintaining a healthy weight.

Diabetes Tests and Diagnosis

Doctors may use certain diabetes tests or a combination of tests to help diagnose diabetes. The three main tests are: A1C, a fasting plasma glucose test and a glucose tolerance test.

The hemoglobin A1C test, or HbA1c, measures average blood sugar over three months. Fasting plasma glucose, or FPG, measures blood sugar levels after fasting for at least eight hours. The oral glucose tolerance test measures blood sugar control, measuring fasting blood sugar levels and testing again two hours after drinking a sugary solution.

Medical providers may also use ketone testing for people with Type 1 diabetes. Ketones are a sign that the body is using fat for energy instead of carbohydrates or sugar. Abnormally high ketone levels are characteristic of a condition called diabetic ketoacidosis, which can lead to coma or even death.



Diabetes Treatment

Diabetes treatment typically includes a combination of lifestyle changes and medications. People with Type 2 may require a combination of medications. As the disease progresses, dosages may increase and insulin may be added.

Type 1 Diabetes Medications

Everyone with Type 1 diabetes must take insulin to keep their blood sugars under control. People with Type 1 don’t typically need other types of medication, but they must constantly check their blood sugar, watch their carbohydrate intake and make sure they don’t exercise too much without taking in extra carbs to keep their sugars from going too low.

Pens, pumps or syringes are the standard ways people with Type 1 get insulin. Four different types of insulin for patients with diabetes include rapid-acting, short-acting, intermediate-acting and long-acting.

Type of InsulinBrand NameOnset of Insulin's EffectsDuration of Dose
Rapid-actingHumalog Novolog Apidra10 to 30 minutes (usually taken just before eating)3 to 5 hours
Short-actingRegular (R)30 minutes to 1 hour (usually taken 30 minutes prior to a meal)Up to 12 hours
Intermediate-actingNPH (N)1.5 to 4 hoursUp to 24 hours (but usually taken twice a day)
Long-actingBasaglar Lantus Levemir Toujeo TresibaAbout 45 minutes to 4 hoursUp to 24 hours

Insulin is generally considered safe if used as directed. It is even the preferred drug over oral drugs to control blood glucose levels during pregnancy and when breastfeeding. However, insulin is not without side effects. Hypoglycemia (low blood sugar) is the most common side effect experienced in patients taking insulin.

Type 2 Diabetes Medications

People with Type 2 diabetes need to take medications to control blood sugar. Many of these are orally available, while others need to be injected. The type, combination and dosage of drugs needed to manage blood sugar will vary depending on the severity of the disease and if other conditions such as heart disease are present.

There are several types of Type 2 medications that belong to different drug classes. People with Type 2 diabetes may take more than one medication at once to control blood sugar.

Type 2 Diabetes Medications
  • Biguanides: Currently, there is only one drug in this class available on the market – Glucophage (metformin). Metformin makes the body more sensitive to insulin, helping to reduce blood sugar. Metformin is inexpensive, well tolerated, and is still considered the first-line treatment of Type 2 diabetes.
  • Dipeptidyl peptidase-4 inhibitors: DPP-4 inhibitors keep the hormone incretin from being broken down, stimulating insulin production and slowing digestion. Popular brand names are Januvia, Onglyza and Tradjenta. Generic names are sitagliptin, saxagliptin and linagliptin.
  • GLP-1 receptor agonists: These injectables help your body respond better to insulin. They also help with weight loss and may reduce the risk of cardiovascular disease. Although expensive, GLP-1 agonists are preferred over insulin, according to the most recent treatment guidelines. These drugs include Ozempic and Trulicity. Insulin is often prescribed to reduce blood sugar. Current guidelines recommend insulin in combination with GLP-1 agonists.
  • Sodium-glucose co-transporter 2 (SGLT2) inhibitors release excess blood glucose through urination. Medications in this class include Invokana and Farxiga.
  • Sulfonylureas: These medications stimulate the pancreas to secrete more insulin. Second generation sulfonylureas are inexpensive and are among the most commonly prescribed Type 2 diabetes drugs. These include glipizide (Glucotrol) and others.
  • Thiazolidinediones (TZDs): These make muscle, fat and liver cells more sensitive to insulin, which helps decrease blood glucose levels. The two most popular drugs in this class are Actos and Avandia.

Doctors may switch medications periodically depending on how a patient reacts to a medication. It’s important to have routine checkups with your medical provider to see if your medications are working and to discuss any side effects.

Living with Diabetes

Diabetes is a chronic medical condition, but it’s possible to maintain healthy blood sugar levels and live well with diabetes. Taking your medication as prescribed and eating a healthy diabetes diet can improve your quality of life and keep complications at bay.

Nutritionist Rebecca Montrone discusses the role of diet and exercise in Type 2 diabetes management.

Regular exercise also improves blood sugar levels and insulin sensitivity. Research in the journal Diabetologia showed that short 10-minute walks after meals help lower blood sugar. Researchers at the University of Otago in New Zealand found short walks after meals controlled blood glucose 12% better than a single 30-minute walk.

Complications of Diabetes

Diabetes is a serious condition that can result in severe complications if not managed properly. One of the most common short-term diabetes complications is hypoglycemia, or low blood sugar. If not treated, hypoglycemia can lead to coma or death.

While diabetic ketoacidosis (DKA) is a rare side effect of some Type 2 diabetes medications, it is most common in undiagnosed or untreated Type 1 diabetes. Diabetic ketoacidosis occurs when the body cannot use glucose for fuel and burns fat instead. The byproducts of breaking down fat are called ketones. When ketones build up in the body, they become toxic.

If left untreated, diabetes can lead to other health issues, including skin problems, kidney disease, heart disease, stroke, high blood pressure, nerve damage and eye problems. Diabetes is the number one cause of lower limb amputation.

How to Prevent Type 2 Diabetes

Adopting a healthy lifestyle, maintaining a healthy weight and getting regular exercise can help people prevent diabetes. Small improvements to eating and exercise habits can make a big difference. Your doctor can recommend a plan to help you maintain healthy blood sugar levels.

The National Institute of Diabetes and Digestive and Kidney Diseases developed the Diabetes Prevention Program (DPP) and ongoing DPP Outcomes Study to help people reduce their risk and track the results. This program showed that people who made recommended lifestyle changes reduced their diabetes risk and prevented or delayed the disease.

You can find out more about these programs by visiting the CDC or the American Diabetes Association.



Please seek the advice of a medical professional before making health care decisions.