Diabetes Guide: Types, Risks, Symptoms, and Management

Diabetes is a disease caused by changing how your body uses food for energy. When we eat food, typically, it’s broken down by our body into sugar (glucose), which flows into the bloodstream. It causes the pancreas to produce insulin, which delivers glucose into cells for fuel. With diabetes, you’re either unable to make enough insulin or are incapable of using it correctly, and so your blood sugar is elevated. And in the long run, that sugar is what causes terrible health problems, including heart disease, blindness, and kidney failure.

The disease is becoming epidemic in the United States: around 38 million adults have diabetes, and 1 in 5 don’t know they have it. It’s the eighth leading cause of death and the leading cause of kidney failure, lower-limb amputations, and blindness in adults. The three main kinds of diabetes are type 1, 2, and gestational diabetes. Type 1 is an autoimmune disease that shuts off insulin, and you need to take insulin every day. The most common type is 2, which occurs gradually because of insulin resistance and is more likely to be a lifestyle issue. Gestational diabetes develops in utero and increases mother and child’s later risk for Type 2 diabetes. Even though diabetes is incurable, it can be managed with lifestyle choices of diet, exercise, and weight loss to manage blood sugar.

Types of Diabetes

Diabetes is a chronic disease that leads to high blood glucose because of the body’s inability to use insulin efficiently. There are three main types of diabetes:

Type 1 Diabetes

Diabetes Type 1 is an autoimmune disorder when the body attacks insulin-secreting beta cells in the pancreas instead of a beta cell. This response severely reduces or even suppresses insulin – a hormone that helps blood sugar pass into cells for fuel. Without insulin, blood sugar builds up in the body, leading to severe complications of diabetes. Type 1 was once called insulin-dependent or juvenile diabetes, but it can affect anyone. Less common than Type 2 diabetes, which is about 5-10% of all people living with diabetes do not know the cause, but genes and environmental factors (viruses) are believed to play a role. Your diet or lifestyle doesn’t affect whether you develop Type 1 diabetes. To control Type 1 diabetes, you need to inject insulin daily (or use a pump; pills don’t work) and monitor your blood sugar regularly.

Type 2 Diabetes

Type 2 diabetes is progressive and usually starts with insulin resistance, in which cells no longer respond to insulin, a hormone that controls blood sugar. That resistance makes the pancreas work harder and release more insulin to stabilize blood sugar. In time, though, blood sugar rises, causing prediabetes and eventually Type 2 diabetes. Genetics, weight (especially around the belly button), age, and inactivity can contribute to insulin resistance, often resulting in high blood sugar, elevated triglycerides, low HDL, and high LDL.

Gestational Diabetes

Gestational diabetes develops during pregnancy and affects 2%–10% of pregnant women in the US. It is caused when you don’t have enough insulin to keep blood sugar under control due to hormonal changes during pregnancy and higher levels of insulin resistance. The earlier a woman gets pregnant, the greater the risk of insulin resistance. A healthy pregnancy and baby are possible with the proper management. Gestational diabetes usually doesn’t manifest, so it needs to be confirmed. Risk factors include a family history of diabetes, obesity, and old age.

Developing gestational diabetes is associated with some complications for mother and child:

• Health of Mother: High blood pressure, possibly C-section.

• Baby’s Health: There is more chance of big (9+ lb), early labor, low blood sugar, and future type 2 diabetes.

While blood sugar usually returns to normal post-partum, half of gestational diabetic women develop type 2 diabetes later. Keeping your weight in a normal range and checking your blood sugar after birth will minimize this risk.

Risk Factors for Diabetes

There are many genetic, behavioral, and lifestyle risk factors for diabetes. Here’s a list of risk factors for Type 1 and Type 2 diabetes:

Type 1 Diabetes Risk Factors

• Genetics: If you have a parent or sibling with Type 1 diabetes, you are at higher risk.

• Age: Type 1 diabetes usually occurs in children, teens, or adults.

• Race: Prevalence highest among White U.S.

Type 2 Diabetes Risk Factors

• Prediabetes: Prediabetic People are more likely to have Type 2 diabetes.

• Obesity: Body weight excess around the abdomen is another factor.

• Lack of Physical Activity: Inactivity is a big culprit for insulin resistance.

• Family History: A family history of Type 2 diabetes adds risk.

• Age: Type 2 diabetes is prevalent after the age of 45.

• Race: More vulnerable African American, Hispanic, Native American, Asian American, and Pacific Islander.

• Chronic Stress: Stress causes lifestyle and hormonal changes that cause diabetes.

Awareness of these risk factors can benefit preventative action and early detection in at-risk groups.

Symptoms of Diabetes

You need to see a doctor and get your blood sugar tested if you have any of the following symptoms:

• Frequent urination, especially at night

• Intense thirst

• Unintentional weight loss

• Constant hunger

• Blurry vision

• Achy hands or feet/tingling sensation.

• Extreme fatigue

• Dry skin

• Slow-healing sores

• Frequent infections

Type 1 Diabetes Symptoms

Type 1 diabetes takes years to set in, sometimes only weeks, often with pronounced symptoms. It can also happen in people with type 1 diabetes who feel nausea, vomiting, and abdominal pain. Such a disease can be diagnosed at any age.

Type 2 Diabetes Symptoms

The symptoms of Type 2 diabetes usually manifest slowly, years in the future, and are not as noticeable. Some people won’t have symptoms at all. Type 2 diabetes is most common in adulthood, although it’s now becoming diagnosed in children and teens. It’s essential to understand the risk factors for Type 2 diabetes so it can be managed before it is too late.

Gestational Diabetes Symptoms

When you’re pregnant, gestational diabetes usually comes with no symptoms. Test for gestational diabetes at 24 to 28 weeks of pregnancy to take care of both mother and fetus.

Diagnosing Diabetes

If you think you have diabetes, your doctor will run a test or several to verify. All these tests measure blood sugar and detect prediabetes, Type 1, Type 2, or gestational diabetes. Here are the most common diabetes tests:

A1C Test: The A1C test provides an average of blood sugar levels over the past 3-4 months.

• Normal: Below 5.7%

• Prediabetes: 5.7% to 6.4%

• Diabetes: 6.5% or above

Fasting Blood Sugar Test: This test measures your blood sugar after fasting (not eating) for at least 8 hours.

• Normal: 99 mg/dL or lower

• Prediabetes: 100 to 125 mg/dL

• Diabetes: 126 mg/dL or higher

Glucose Tolerance Test: This test measures blood sugar before and after you drink a glucose solution. It is checked every 2-3 hours.

• Regular: 140 mg/dL or lower

• Prediabetes: 140 to 199 mg/dL

• Diabetes: 200 mg/dL or higher

Gestational diabetes is diagnosed at 24–28 weeks of pregnancy. The primary tests are:

• Glucose Screen Test: A glucose solution is administered 1 hour after taking blood. (A follow-up is needed if the glucose level exceeds 140 mg/dL.)

• Glucose Tolerance Test: This is similar to the tolerance test for other types of diabetes, which involves several blood tests after fasting and drinking a glucose solution.

Testing Preparation and Frequency

Most tests, notably fasting blood sugar and glucose tolerance tests, require fasting to get the results right. If you have risk factors for diabetes, your doctor will arrange regular testing based on your needs. People who have gestational diabetes or prediabetes might need more frequent checks to control the risk.

Diabetes Statistics and Societal Impact

As of 2021, approximately 38.4 million people in the U.S., or 11.6% of the population, were living with diabetes. Among adults 18 and older, 14.7%, or 38.1 million, had diabetes. Disturbingly, 8.7 million of these adults met the laboratory definition of diabetes but never had or never mentioned diabetes, which made up 22.8% of all American adults with diabetes. Diabetes also gets worse with age – 21.9% of adults over 65 are living with diabetes.

Financial Burden of Treatment

The cost of diabetes in the U.S. is enormous. As of 2022, the estimated direct and indirect cost of diagnosed diabetes was $413 billion. Med Costs directly associated with treating diabetes alone increased from $227 billion in 2012 to $307 billion in 2022. Indirect costs of productivity loss from work absenteeism, productivity decline, unemployment caused by chronic disability, and premature death went up from $89 billion to $106 billion over the same period.

Diabetes costs have also soared. Excess medical expenses per person with diabetes were $10,179 in 2012. By 2022, those costs rose to $12,022 as diabetes-related complications and treatments became increasingly expensive.

Societal Significance

Diabetes affects a highly diverse range of people across the U.S. population: a total of 29.7 million people (8.9% of the population) were living with diabetes in 2021, 352,000 of them being children and adolescents, a majority with Type 1 diabetes. The rate of diabetes differs by race, income, and region. Adults of American Indian and Alaska Native ethnicity have the highest rate (13.6%), non-Hispanic Black (12.1%), and Hispanic adults (11.7%). Prevalence is also influenced by education and income levels, with higher rates among those with lower education and family incomes. Nonmetropolitan regions also experience high diabetes rates, similar to urban communities, highlighting the need for targeted health interventions for at-risk groups.

Consequences of Rising Diabetes Rates

Diabetes has profound health effects, both in terms of quality of life and mortality. Kidney disease is prevalent among adults with diagnosed diabetes, with 39.2% affected by chronic kidney disease (CKD) and 15.7% at moderate to severe stages (3 or 4). Second, diabetes still leads the path to end-stage kidney disease (39.2% of all cases in 2019), followed by high blood pressure.

Diabetes is responsible for nearly all new cases of blindness among adults aged 18–64. 10.1% of U.S. adults with diabetes had a diagnosis of severe eye impairment or blindness as of 2021. Diabetes was the eighth leading cause of death in 2021 – 103,294 deaths directly caused by it – and listed as a cause of nearly 400,000 deaths in 2021. These dire effects indicate the need for proactive prevention and control.

Complications and Health Impact

Diabetes poses a significant cardiovascular risk, as individuals with diabetes are twice as likely to develop heart disease or experience a stroke compared to those without the condition – prolonged high blood sugar damages the blood vessels and nerves vital to heart health. Several factors (including high blood pressure, high cholesterol, and high triglycerides) among the chronically obese add to these dangers. Maintaining a healthy lifestyle, such as a well-balanced diet, regular physical activity, weight control, and abstention from smoking and drinking, is crucial for preventing diabetes and health. Lifestyle modifications, early diagnosis, and health promotion programs will significantly mitigate the risk of diabetes. Stress management, through exercise, psychotherapy, or meditation, also helps keep the heart healthy. Medications may be prescribed to help manage blood sugar, cholesterol levels, and blood pressure.

Diabetic Ketoacidosis (DKA)

DKA is a life-threatening condition that typically affects people with Type 1 diabetes but can also occur in those with Type 2. DKA occurs when the body lacks sufficient insulin for processing blood sugar, causing it to break down fat for energy. The ketones that come out of this process are dangerous. In the early stages, tremors and frequent urination lead to rapid breathing, nausea, floral breath, and loss of understanding. To avoid DKA, one needs to check your blood sugar regularly, follow the correct insulin dosage, and be observant of any symptoms when sick. The patient must be immediately treated, or else they can go into severe dehydration, coma, or even death from DKA if it’s left untreated.

Preventing Diabetes

Preventing diabetes (most notably Type 2) is possible with lifestyle modifications and risk-reducing support services. In the US, several diabetes prevention programs devoted to education and monitoring exist.

Diabetes Prevention Programs in the United States.

The CDC-supported National Diabetes Prevention Program (DPP) provides structured information for lifestyle modifications over time. This community-based program, with online and in-person variants, offers resources for people at risk of developing diabetes.

Role of a Healthy Lifestyle in Prevention

A healthy lifestyle is the key to diabetes prevention:

• Healthy Diet: Eat many whole foods like fruits, vegetables, whole grains, and lean proteins. Cutting down on processed foods and sugars prevents the rise and fall of blood sugar and keeps you from gaining weight.

• Exercise: Physical activity increases insulin sensitivity and supports healthy blood sugar.

• Weight Management: Losing just a few pounds (5-7%) can reduce the risk of diabetes considerably, especially in those with prediabetes.

Recommendations to Reduce Diabetes Risks

• Keep Fit: Do some aerobic exercise and strength training as well.

• Regular Screening: If you are at high risk (based on family history, age, or obesity), get your blood sugar checked frequently to catch any symptoms early.

• Avoid Tobacco and Limit Alcohol: Smoking and drinking too much can cause diabetes and heart disease.

• Look For Help: Local or online organizations can provide support and reassurance.

Making lifestyle changes early can delay or prevent diabetes and help with general health.

The Role of Nutrition and Fiber

Diet is essential in controlling diabetes, and fiber is an important factor in blood sugar, heart health, and weight loss. Even so, most adults in the United States only get around half of the daily recommended dose of fiber. Fibrous foods such as fruits, vegetables, whole grains, and legumes can also significantly help if you have diabetes or prediabetes.

Effect of Fiber on Blood Sugar Regulation

Fibre, a carb, doesn’t go through digestion like other carbs, so that you won’t experience spikes in blood sugar. It maintains the balance of blood sugar for better diabetes management. Soluble fiber that soaks into the water and produces a gel-like substance, particularly useful for blood sugar regulation, is abundant in oats, beans, and apples.

Heart Health Benefits of Fiber

Fiber also lowers cholesterol by stopping the body from absorbing some fats and preventing heart disease. Soluble and insoluble fiber help with these since insoluble fiber maintains healthy bowel function and raises insulin sensitivity.

Ways to Boost Fiber Intake

• Start with Breakfast: Eat avocado toast or oatmeal with berries and nuts.

• Choose Whole Grains: Opt for wholegrain bread, brown rice, and wholewheat pasta.

• Add Vegetables: Include not starchy greens such as spinach, broccoli, or mixed greens in your meal.

• Include Legumes: Serve beans or lentils in salads, soups, or casseroles.

• Snack Smartly: Snack on fibrous foods like apples, nuts, and carrots.

Fibre should be introduced slowly so you don’t get digestive issues, and drink plenty of water. A fiber-rich diet helps to control diabetes and stabilize blood sugar, heart health, and overall well-being. Get your fiber-eating plan established with a dietitian or diabetes educator.

Meal Planning Methods for People with Diabetes

Create a healthy menu plan to prevent diabetes and maintain healthy blood sugar levels. Here’s a rundown of the meal-planning tricks that will get you started.

The Plate Method

The plate is a visual, easy-to-follow way to meal plan with a combination of non-starchy vegetables, lean proteins, and carbs:

• Use a 9-inch Plate: Try to find a plate the size of a business envelope.

• Half the Plate: Layer non-starchy veggies such as spinach, broccoli, and carrots that are low in carbs and regulate blood sugar.

• One Quarter: Serve with a protein source like chicken, fish, tofu, or beans.

• Quarter: Set aside for carbs (whole grains, starchy veggies, fruit).

• Beverage Choice: Choose water or another low-calorie drink.

Carbohydrate Counting

Another blood sugar control measure is to count carbohydrates. You can get the carbs quickly: carbs spike your blood sugar quickly (mainly processed ones), so you want to ensure you eat the same amount at every meal. Discuss with your dietitian a daily carb goal that works for you.

Portion Control Tips

Balanced meals are essential for managing blood sugar and weight:

• Restaurants: Ask for half the meal and split with a friend.

• Home: Make portions and avoid eating out of big bowls.

• "Handy" Guide: Work out portion sizes with your hand: 3 oz flesh = palm; 1 cup fruit or vegetables = fist; 2 tablespoons = thumb base to the first joint.

With these meal-plan tips, you can maintain a healthy blood sugar level and eat a varied diet.