Diabetes Basics

Diabetes is a common, long-term health condition that occurs when the body cannot control blood sugar levels. Whether you’re newly diagnosed or know someone with diabetes, we go over the basics of diabetes and other key facts so you can understand more about this condition.

What is Diabetes?

Diabetes mellitus is a condition where glucose (or sugar) in the blood exceeds normal or healthy levels. This is due to inadequate insulin production by the pancreas (“organ dysfunction”) and/or the body’s inability to use insulin effectively (“insulin resistance”). 

Insulin is a vital hormone released by the pancreas and absorbs blood glucose into the cells. But when there isn’t enough insulin, glucose stays in the blood and over time leads to several disorders and complications.

Type 1 and Type 2 Diabetes

There are actually four classes of diabetes: Type 1, Type 2, gestational and diabetes caused by specific conditions. 

  • Type 1: the pancreas is affected by an autoimmune condition that impairs the production of insulin.  Type 1 diabetes can occur in children as well as later into adulthood.
  • Type 2: the pancreas can’t produce adequate insulin because it’s been overworked after years of high blood glucose levels.  The pancreas has been stressed from continually producing insulin while the cells become more insulin resistant. Lifestyle choices are highly associated with pancreatic dysfunction. 
  • Gestational diabetes occurs in pregnant women, when hormonal changes during pregnancy causes insulin resistance. 
  • Diabetes can also be caused by specific conditions but isn’t as common as the other types. The conditions could be diseases affecting the pancreas (such as pancreatitis) or drug- or chemical-induced diabetes (such as using glucocorticoid after organ transplantation).

How is it Diagnosed?

Diabetes is diagnosed if measured blood glucose levels is outside of the normal or healthy range (charted below).

A common measurement is Hemoglobin A1C, which generally reflects a blood sugar average from the last 2-3 months.  Other common measurements are fasting glucose and glucose tolerance tests done through blood tests at a lab.

StageHemoglobin A1CFasting Plasma Glucose (FPG)Oral Glucose Tolerance Test
NormalA1C < 5.7%FPG < 100 mg/dl2-hour Plasma Glucose (2hPG) < 140 mg/dl
PrediabetesA1C = 5.7% – 6.4%FPG = 100-125 mg/dl2hPG = 140 -199 mg/dl
DiabetesA1C ≥ 6.5%FPG ≥ 126 mg/dl2hPG ≥ 200 mg/dl
Source: ADA 2021 Standards of Care

Diabetes in the U.S.

According to the CDC’s 2020 Diabetes Statistics Report, over 34 million Americans have diabetes (1 out of 10 people) and 88 million have pre-diabetes (1 out of 3 people). 

The rate of this condition among adolescents (under 20 years old) also significantly increased the past several years.  This is concerning as the CDC’s report showed that diabetes was the 7th leading cause of death in 2017.

Complications

High blood glucose levels over time can restrict blood flow, damage blood vessels and reduce blood supply needed throughout the body. This can lead to serious health complications such as microvascular and macrovascular diseases.  

Microvascular Disease

Diabetes can cause microvascular diseases which are caused by damaging small blood vessels located in the eyes (retinopathy), kidneys (nephropathy), and nerves (neuropathy).

Retinopathy is caused by damaged blood vessels in the back lining of the eye and is the leading cause of blindness.

Nephropathy occurs when damaged blood vessels prevent the kidney from functioning properly and can lead to kidney failure. Neuropathy is caused by damage to the nerves, which can disrupt how your nerves communicate to different limbs and organs.

Macrovascular Disease

Diabetes also increases the risk of macrovascular diseases, which are caused by damage to the large blood vessels and include coronary artery disease and stroke. 

Coronary artery disease is caused by damaged blood vessels that supply the heart and can cause heart attacks, heart failure or irregular heartbeats. Strokes occur when the blood supply to the brain suddenly stops – this is worsened when there is damage to the blood vessels that supply the brain.

Treatment and Management

While there is no complete cure for diabetes, medications and lifestyle changes can control diabetes to a manageable level in order to prevent complications.

Medication

Insulin is the most common medication prescribed for diabetes as it lowers blood glucose to normal/healthy ranges. Metformin is another common medication that is used to prevent the liver from releasing sugar and increase insulin sensitivity.

insulin pen for diabetes
Insulin pen used for diabetes

There are several other medications generally designed to lower blood sugar but target different organs such as  glipizide, jardiance and victoza.

Lifestyle

Lifestyle choices are also effective for controlling diabetes, particularly a combination of diet and active living. 

Diet is important because the amount of sugar (or carbohydrates) in the foods you eat impacts your blood glucose levels. Generally speaking, lowering carbohydrate intake will help lower blood glucose levels. 

Staying active is equally important because exercise uses carbs for energy, thus removing glucose in the blood. Staying active also helps with insulin sensitivity, weight and fat loss, and increasing muscles – all of which can reduce the risk of other diseases.

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