Diabetes is a condition that occur when your glucose level (blood sugar) is too high. It develops when your pancreas doesn’t make enough insulin or any at all, or when your body isn’t responding to the effects of insulin properly.
Diabetes affects people of all ages. Most forms of diabetes are chronic (lifelong), and all forms are manageable with medications and/or lifestyle changes.
The main cause of diabetes varies by type. But no matter what type of diabetes you have, it can lead to excess sugar in the blood. Too much sugar in the blood can lead to serious health problems.
Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes and gestational diabetes. Prediabetes happens when blood sugar levels are higher than normal. But the blood sugar levels aren’t high enough to be called diabetes. And prediabetes can lead to diabetes unless steps are taken to prevent it.
Gestational diabetes happens during pregnancy. But it may go away after the baby is born.
Table of Contents
Types of diabetes
There are several types of diabetes. The most common forms include:
Type 1 diabetes
This type is an autoimmune disease in which your immune system attacks and destroys insulin-producing cells in your pancreas for unknown reasons. Up to 10% of people who have diabetes have Type 1. It’s usually diagnosed in children and young adults, but it can develop at any age.
Type 2 diabetes
With this type, your body doesn’t make enough insulin and/or your body’s cells don’t respond normally to the insulin (insulin resistance). This is the most common type of diabetes. It mainly affects adults, but children can have it as well.
Gestational diabetes
This type develops in some people during pregnancy. Gestational diabetes usually goes away after pregnancy. However, if you have gestational diabetes, you’re at a higher risk of developing Type 2 diabetes later in life.
Prediabetes
This type is the stage before Type 2 diabetes. Your blood glucose levels are higher than normal but not high enough to be officially diagnosed with Type 2 diabetes.
Other types of diabetes include:
- Type 3c diabetes: This form of diabetes happens when your pancreas experiences damage (other than autoimmune damage), which affects its ability to produce insulin. Pancreatitis, pancreatic cancer, cystic fibrosis and hemochromatosis can all lead to pancreas damage that causes diabetes. Having your pancreas removed (pancreatectomy) also results in Type 3c.
- Latent autoimmune diabetes in adults (LADA): Like Type 1 diabetes, LADA also results from an autoimmune reaction, but it develops much more slowly than Type 1. People diagnosed with LADA are usually over the age of 30.
- Maturity-onset diabetes of the young (MODY): MODY, also called monogenic diabetes, happens due to an inherited genetic mutation that affects how your body makes and uses insulin. There are currently over 10 different types of MODY. It affects up to 5% of people with diabetes and commonly runs in families.
- Neonatal diabetes: This is a rare form of diabetes that occurs within the first six months of life. It’s also a form of monogenic diabetes. About 50% of babies with neonatal diabetes have the lifelong form called permanent neonatal diabetes mellitus. For the other half, the condition disappears within a few months from onset, but it can come back later in life. This is called transient neonatal diabetes mellitus.
- Brittle diabetes: Brittle diabetes is a form of Type 1 diabetes that’s marked by frequent and severe episodes of high and low blood sugar levels. This instability often leads to hospitalization. In rare cases, a pancreas transplant may be necessary to permanently treat brittle diabetes.
Symptoms of diabetes
The symptoms of type 1, type 2, and type 1.5 (LADA) are the same, but they occur in a shorter period than types 2 and 1.5. In type 2, the onset tends to be slower. Tingling nerves and slow-healing sores are more common in type 2.
Left untreated, type 1, in particular, can lead to diabetic ketoacidosis. This is when there is a dangerous level of ketones in the body. It’s less common in other types of diabetes, but still possible. The general symptoms of diabetes include:
- increased hunger
- increased thirst
- weight loss
- frequent urination
- blurry vision
- extreme fatigue
- sores that don’t heal
In addition to the general symptoms of diabetes, men with diabetes may have:
- a decreased sex drive
- erectile dysfunction
- poor muscle strength
Women with diabetes can have symptoms such as:
- vaginal dryness
- urinary tract infections
- yeast infections
- dry, itchy skin
Gestational diabetes
Most people who develop gestational diabetes don’t have any symptoms. Healthcare professionals often detect the condition during a routine blood sugar test or oral glucose tolerance test, which is usually performed between the 24th and 28th weeks of pregnancy.
In rare cases, a person with gestational diabetes will also experience increased thirst or urination.
Generally diabetes symptoms can be so mild that they’re hard to spot at first.
You should see a doctor if:
- If you’ve already been diagnosed with diabetes. After you receive your diagnosis, you’ll need close medical follow-up until your blood sugar levels stabilize.
- If you think you or your child may have diabetes. If you notice any possible diabetes symptoms, contact your health care provider. The earlier the condition is diagnosed, the sooner treatment can begin.
You can also read about the symptoms and causes of high blood pressure.
Causes of diabetes
Too much glucose circulating in your bloodstream causes diabetes, regardless of the type. However, the reason why your blood glucose levels are high differs depending on the type of diabetes.
Causes of diabetes include the following:
- Insulin resistance: Type 2 diabetes mainly results from insulin resistance. Insulin resistance happens when cells in your muscles, fat and liver don’t respond as they should to insulin. Several factors and conditions contribute to varying degrees of insulin resistance, including obesity, lack of physical activity, diet, hormonal imbalances, genetics and certain medications.
- Autoimmune disease: Type 1 diabetes and LADA happen when your immune system attacks the insulin-producing cells in your pancreas.
- Hormonal imbalances: During pregnancy, the placenta releases hormones that cause insulin resistance. You may develop gestational diabetes if your pancreas can’t produce enough insulin to overcome the insulin resistance. Other hormone-related conditions like acromegaly and Cushing syndrome can also cause Type 2 diabetes.
- Pancreatic damage: Physical damage to your pancreas — from a condition, surgery or injury — can impact its ability to make insulin, resulting in Type 3c diabetes.
- Genetic mutations: Certain genetic mutations can cause MODY and neonatal diabetes.
- Long-term use of certain medications can also lead to Type 2 diabetes, including HIV/AIDS medications and corticosteroids.
Risk factors of diabetes
Certain factors increase your risk for diabetes.
You’re more likely to get type 1 diabetes if you’re a child or teenager, you have a parent or sibling with the condition, or you carry certain genes that are linked to the disease.
Your risk for type 2 diabetes increases if you:
- are overweight
- are age 45 or older
- have a parent or sibling with the condition
- aren’t physically active
- have had gestational diabetes
- have prediabetes
- have high blood pressure, high cholesterol, or high triglycerides
Type 2 diabetes also disproportionately affects certain racial and ethnic populations.
Your risk for gestational diabetes increases if you:
- are overweight
- are over age 25
- had gestational diabetes during a past pregnancy
- have given birth to a baby weighing more than 9 pounds
- have a family history of type 2 diabetes
- have polycystic ovary syndrome (PCOS)
Your family history, environment, and preexisting medical conditions can all affect your odds of developing diabetes.
You can also read about the risk factors and complications of stroke.
Complications of diabetes
Long-term complications of diabetes develop gradually. The longer you have diabetes and the less controlled your blood sugar, the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. In fact, prediabetes can lead to type 2 diabetes. Possible complications include:
- Nerve damage from diabetes (diabetic neuropathy). Too much sugar can injure the walls of the tiny blood vessels (capillaries) that nourish the nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.
- Heart and blood vessel (cardiovascular) disease. Diabetes majorly increases the risk of many heart problems. These can include coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you’re more likely to have heart disease or stroke.
- Kidney damage from diabetes (diabetic nephropathy). The kidneys hold millions of tiny blood vessel clusters (glomeruli) that filter waste from the blood. Diabetes can damage this delicate filtering system.
- Eye damage from diabetes (diabetic retinopathy). Diabetes can damage the blood vessels of the eye. This could lead to blindness.
- Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of many foot complications.
- Skin and mouth conditions. Diabetes may leave you more prone to skin problems, including bacterial and fungal infections.
- Hearing impairment. Hearing problems are more common in people with diabetes.
- Depression related to diabetes. Depression symptoms are common in people with type 1 and type 2 diabetes.
- Alzheimer’s disease. Type 2 diabetes may increase the risk of dementia, such as Alzheimer’s disease.
Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for you and your baby.
Complications in your baby can be caused by gestational diabetes, including:
- Low blood sugar. Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth. This is because their own insulin production is high.
- Excess growth. Extra glucose can cross the placenta. Extra glucose triggers the baby’s pancreas to make extra insulin. This can cause your baby to grow too large. It can lead to a difficult birth and sometimes the need for a C-section.
- Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
- Death. Untreated gestational diabetes can lead to a baby’s death either before or shortly after birth.
Complications in the mother also can be caused by gestational diabetes, including:
- Gestational diabetes. If you had gestational diabetes in one pregnancy, you’re more likely to have it again with the next pregnancy.
- Preeclampsia. Symptoms of this condition include high blood pressure, too much protein in the urine, and swelling in the legs and feet.
You can also read about the risk factors and complication of preeclampsia.
Prevention of diabetes
Type 1 diabetes are not preventable because they are caused by an issue with the immune system. Some causes of type 2 diabetes, such as your genes or age, aren’t under your control either.
Yet many other diabetes risk factors are manageable. Most diabetes prevention strategies involve making simple adjustments to your diet and fitness routine.
If you’ve received a diagnosis of prediabetes, here are a few things you can do to delay or prevent type 2 diabetes:
- Get at least 150 minutes per week of aerobic exercises like walking or cycling.
- Cut saturated and trans fats, along with refined carbohydrates, out of your diet.
- Eat more fruits, vegetables, and whole grains.
- Eat smaller portions.
- Try to lose 5% to 7% of your body weight if you have overweight or obesity.
People who’ve never had diabetes can suddenly develop gestational diabetes during pregnancy. Hormones produced by the placenta can make your body more resistant to the effects of insulin.
People can have diabetes before they conceive and carry it with them into pregnancy. This is called
Diagnosis of diabetes
Type 1 diabetes symptoms often start suddenly and are often the reason for checking blood sugar levels. Because symptoms of other types of diabetes and prediabetes come on more gradually or may not be easy to see, the American Diabetes Association (ADA) has developed screening guidelines. The ADA recommends that the following people be screened for diabetes:
- Anyone with a body mass index higher than 25 (23 for Asian Americans), regardless of age, who has additional risk factors. These factors include high blood pressure, non-typical cholesterol levels, an inactive lifestyle, a history of polycystic ovary syndrome or heart disease, and having a close relative with diabetes.
- Anyone older than age 35 is advised to get an initial blood sugar screening. If the results are normal, they should be screened every three years after that.
- Women who have had gestational diabetes are advised to be screened for diabetes every three years.
- Anyone who has been diagnosed with prediabetes is advised to be tested every year.
- Anyone who has HIV is advised to be tested.
Healthcare providers diagnose diabetes by checking your glucose level in a blood test. Tests for type 1 and type 2 diabetes and prediabetes include:
- A1C test. This blood test, which doesn’t require not eating for a period of time (fasting), shows your average blood sugar level for the past 2 to 3 months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. It’s also called a glycated hemoglobin test. The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached. An A1C level of 6.5% or higher on two separate tests means that you have diabetes. An A1C between 5.7% and 6.4% means that you have prediabetes. Below 5.7% is considered normal.
- Random blood sugar test. A blood sample will be taken at a random time. No matter when you last ate, a blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1 millimoles per liter (mmol/L) — or higher suggests diabetes.
- Fasting blood sugar test. A blood sample will be taken after you haven’t eaten anything the night before (fast). A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it’s 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.
- Glucose tolerance test. For this test, you fast overnight. Then, the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested regularly for the next two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours means you have diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) means you have prediabetes.
If your provider thinks you may have type 1 diabetes, they may test your urine to look for the presence of ketones. Ketones are a byproduct produced when muscle and fat are used for energy. Your provider will also probably run a test to see if you have the destructive immune system cells associated with type 1 diabetes called autoantibodies.
Your provider will likely see if you’re at high risk for gestational diabetes early in your pregnancy. If you’re at high risk, your provider may test for diabetes at your first prenatal visit. If you’re at average risk, you’ll probably be screened sometime during your second trimester.
Treatment of diabetes
Diabetes is a complex condition, so its management involves several strategies. In addition, diabetes affects everyone differently, so management plans are highly individualized. The four main aspects of treating diabetes include:
- Blood sugar monitoring: Monitoring your blood sugar (glucose) is key to determining how well your current treatment plan is working. It gives you information on how to manage your diabetes on a daily — and sometimes even hourly — basis. You can monitor your levels with frequent checks with a glucose meter and finger stick and/or with a continuous glucose monitor (CGM). You and your healthcare provider will determine the best blood sugar range for you.
- Insulin: People with Type 1 diabetes need to inject synthetic insulin to live and manage diabetes. Some people with Type 2 diabetes also require insulin. There are several different types of synthetic insulin. They each start to work at different speeds and last in your body for different lengths of time. The four main ways you can take insulin include injectable insulin with a syringe (shot), insulin pens, insulin pumps and rapid-acting inhaled insulin.
- Oral diabetes medications: Oral diabetes medications (taken by mouth) help manage blood sugar levels in people who have diabetes but still produce some insulin — mainly people with Type 2 diabetes and prediabetes. People with gestational diabetes may also need oral medication. There are several different types. Metformin is the most common.
- Diet: Meal planning and choosing a healthy diet for you are key aspects of diabetes management, as food greatly impacts blood sugar. If you take insulin, counting carbs in the food and drinks you consume is a large part of management. The amount of carbs you eat determines how much insulin you need at meals. Healthy eating habits can also help you manage your weight and reduce your heart disease risk.
- Exercise: Physical activity increases insulin sensitivity (and helps reduce insulin resistance), so regular exercise is an important part of management for all people with diabetes.
Due to the increased risk for heart disease, it’s also important to maintain a healthy:
- Blood pressure.
- Cholesterol.
- Weight.
Insulin therapy
People with type 1 diabetes must use insulin to manage blood sugar to survive. Many people with type 2 diabetes or gestational diabetes also need insulin therapy.
Many types of insulin are available, including short-acting (regular insulin), rapid-acting insulin, long-acting insulin and intermediate options. Depending on your needs, your provider may prescribe a mixture of insulin types to use during the day and night.
Insulin can’t be taken orally to lower blood sugar because stomach enzymes interfere with insulin’s action. Insulin is often injected using a fine needle and syringe or an insulin pen — a device that looks like a large ink pen.
An insulin pump also may be an option. The pump is a device about the size of a small cellphone worn on the outside of your body. A tube connects the reservoir of insulin to a tube (catheter) that’s inserted under the skin of your abdomen.
A continuous glucose monitor, on the left, is a device that measures blood sugar every few minutes using a sensor inserted under the skin. An insulin pump, attached to the pocket, is a device that’s worn outside of the body with a tube that connects the reservoir of insulin to a catheter inserted under the skin of the abdomen. Insulin pumps are programmed to deliver specific amounts of insulin continuously and with food.
A tubeless pump that works wirelessly is also now available. You program an insulin pump to dispense specific amounts of insulin. It can be adjusted to give out more or less insulin depending on meals, activity level and blood sugar level.
A closed loop system is a device implanted in the body that links a continuous glucose monitor to an insulin pump. The monitor checks blood sugar levels regularly. The device automatically delivers the right amount of insulin when the monitor shows that it’s needed.
A closed loop system that doesn’t need any user input isn’t available yet. But more of these systems currently are in clinical trials.
Medications
Sometimes your provider may prescribe other oral or injected drugs as well. Some diabetes drugs help your pancreas to release more insulin. Others prevent the production and release of glucose from your liver, which means you need less insulin to move sugar into your cells.
Still others block the action of stomach or intestinal enzymes that break down carbohydrates, slowing their absorption, or make your tissues more sensitive to insulin. Metformin (Glumetza, Fortamet, others) is generally the first drug prescribed for type 2 diabetes.
Another class of medication called SGLT2 inhibitors may be used. They work by preventing the kidneys from reabsorbing filtered sugar into the blood. Instead, the sugar is eliminated in the urine.
Procedure
In some people who have type 1 diabetes, a pancreas transplant may be an option. Islet transplants are being studied as well. With a successful pancreas transplant, you would no longer need insulin therapy.
But transplants aren’t always successful. And these procedures pose serious risks. You need a lifetime of immune-suppressing drugs to prevent organ rejection. These drugs can have serious side effects. Because of this, transplants are usually reserved for people whose diabetes can’t be controlled or those who also need a kidney transplant.
Bariatric surgery
Some people with type 2 diabetes who are obese and have a body mass index higher than 35 may be helped by some types of bariatric surgery. People who’ve had gastric bypass have seen major improvements in their blood sugar levels. But this procedure’s long-term risks and benefits for type 2 diabetes aren’t yet known.
gestational diabetes
Controlling your blood sugar level is essential to keeping your baby healthy. It can also keep you from having complications during delivery. In addition to having a healthy diet and exercising regularly, your treatment plan for gestational diabetes may include monitoring your blood sugar. In some cases, you may also use insulin or oral drugs.
Your provider will monitor your blood sugar level during labor. If your blood sugar rises, your baby may release high levels of insulin. This can lead to low blood sugar right after birth.
prediabetes
Treatment for prediabetes usually involves healthy lifestyle choices. These habits can help bring your blood sugar level back to normal. Or it could keep it from rising toward the levels seen in type 2 diabetes. Keeping a healthy weight through exercise and healthy eating can help. Exercising at least 150 minutes a week and losing about 7% of your body weight may prevent or delay type 2 diabetes.
Drugs such as metformin, statins and high blood pressure medications may be an option for some people with prediabetes and other conditions such as heart disease.
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