What are the different types of diabetes?
Diabetes is a group of diseases in which the body doesn’t
produce enough or any insulin, doesn’t properly use the insulin that is
produced, or exhibits a combination of both. When any of these things happens,
the body is unable to get sugar from the blood into the cells. That leads to
high blood sugar levels.
Glucose, the form of sugar found in your blood, is one of your
main energy sources. A lack of insulin or resistance to insulin causes sugar to
build up in your blood. This can lead to many health problems.
The three main types of diabetes are:
- type 1 diabetes
- type 2 diabetes
- gestational diabetes
What causes diabetes?
Type 1 diabetes
Type 1 diabetes is believed to be an
autoimmune condition. This means your immune system mistakenly attacks and
destroys the beta cells in your pancreas that produce insulin. The damage
is permanent.
What prompts the attacks isn’t clear. There may be both genetic
and environmental reasons. Lifestyle factors aren’t thought to play a role.
Type 2 diabetes
Type 2 diabetes starts as insulin
resistance. This means your body can’t use insulin efficiently. That stimulates
your pancreas to produce more insulin until it can no longer keep up with
demand. Insulin production decreases, which leads to high blood sugar.
The exact cause of type 2 diabetes is unknown. Contributing
factors may include:
- genetics
- lack of exercise
- being overweight
There may also be other health factors and environmental
reasons.
Gestational diabetes
Gestational diabetes is due to insulin-blocking hormones produced during
pregnancy. This type of diabetes only occurs during pregnancy.
What are the symptoms?
General symptoms of diabetes include:
- excessive
thirst and hunger
- frequent urination
- drowsiness or fatigue
- dry, itchy skin
- blurry
vision
- slow-healing wounds
Type 2 diabetes can cause dark patches in the folds of skin in
your armpits and neck. Since type 2 diabetes often takes longer to diagnose,
you may feel symptoms at the time of diagnosis, like pain or numbness in your
feet.
Type 1 diabetes often develops more quickly and can cause
symptoms like weight loss or a condition called diabetic
ketoacidosis. Diabetic ketoacidosis can occur when you have very
high blood sugars, but little or no insulin in your body.
Symptoms of both types of diabetes can appear at any age, but
generally type 1 occurs in children and young adults. Type 2 occurs in people
over the age of 45. But younger people are increasingly being diagnosed with
type 2 diabetes due to sedentary lifestyles and an increase in weight.
How common is
diabetes?
About 30.3 millionTrusted Source people in the United States
have diabetes. About 5 to 10 percent have type 1 diabetes, while 90 to 95
percent have type 2 diabetes.
The latest figures show that 1.5 million adults were newly
diagnosed in 2015. Another 84.1 million are thought to have prediabetes. But
most people with prediabetes don’t
know they have the condition.
Prediabetes occurs when your blood glucose is higher than it
should be, but not high enough to be diabetes.
You’re more likely to develop diabetes if you have a family history
of the disease.
Other risk factors for type 2 diabetes include:
- having a sedentary lifestyle
- being overweight
- having had gestational diabetes or prediabetes
What are the potential
complications?
Complications of diabetes generally develop over time. Having
poorly controlled blood sugar levels increases the risk of serious
complications that can become life-threatening. Chronic complications include:
- vessel disease, leading to heart attack or stroke
- eye problems, called retinopathy
- infection or skin conditions
- nerve damage, or neuropathy
- kidney damage, or nephropathy
- amputations due to neuropathy or vessel disease
Type 2 diabetes may increase the risk of developing Alzheimer’s disease, especially if your blood
sugar is not well controlled.
Complications in pregnancy
High blood sugar levels during pregnancy can harm mother and
child, increasing the risk of:
- high blood pressure
- preeclampsia
- miscarriage or stillbirth
- birth defects
How are different
types of diabetes treated?
No matter what type of diabetes you have, you’ll need to work
closely with your doctor to keep it under control.
The main goal is to keep blood glucose levels within your target
range. Your doctor will let you know what your target range should be. Targets
vary with the type of diabetes, age, and presence of complications.
If you have gestational diabetes, your blood sugar targets will
be lower than people with other types of diabetes.
Physical activity is an important part of diabetes management.
Ask your doctor how many minutes per week you should devote to aerobic
exercise. Diet is also crucial to good control. You’ll also need to monitor
your blood pressure and cholesterol.
Treating type 1
All people with type 1 diabetes must take insulin to live
because damage to the pancreas is permanent. There are different types of
insulin available with different times of onset, peak, and duration.
Insulin is injected just under the skin. Your doctor will show
you how to properly inject and rotate injection sites. You can also use an
insulin pump, which is a device worn outside your body that can be programmed
to release a specific dose. There are now continuous blood glucose monitors as
well that check your sugar 24 hours a day.
You’ll need to monitor your blood sugar levels throughout the
day. If necessary, you may also need to take medication to control cholesterol,
high blood pressure, or other complications.
Treating type 2
Type 2 diabetes is managed with diet and exercise, and can also
be treated with a variety of medications to help control blood sugar. The
first-line medication is usually metformin (Glumetza, Glucophage, Fortamet,
Riomet). This drug helps your body use insulin more effectively. If metformin
doesn’t work, your doctor can add other medications or try something different.
You’ll need to monitor your blood sugar levels. You may also
need medications to help control blood pressure and cholesterol.
Prevention
There’s no known prevention for type 1 diabetes.
You can lower your risk of type 2 diabetes if you:
- control your weight and manage your diet
- exercise regularly
- avoid smoking, high triglycerides, and low HDL cholesterol levels
If you had gestational diabetes or have prediabetes, these
habits can delay or prevent the onset of type 2 diabetes.
How
insulin problems develop
Doctors do not know the exact causes of type 1 diabetes.
However, insulin resistance, which can lead to type 2 diabetes, has clearer causes.
Insulin allows the glucose from a person’s food to access the
cells in their body to supply energy. Insulin resistance is usually a result of
the followingTrusted Source cycle:
1.
A person has genes or
an environment that make it more likely for them to be unable to produce enough
insulin to cover how much glucose, or sugar, they eat.
2.
The body tries to make
extra insulin to process the excess blood sugar.
3.
The pancreas cannot
keep up with the increased demands, and the excess blood sugar starts to
circulate in the blood, causing damage.
4.
Over time, insulin
becomes less effective at introducing glucose to cells, and blood sugar levels
continue to rise.
With type 2 diabetes, insulin resistance takes place gradually.
This is why doctors often recommend making lifestyle changes in an attempt to
slow or reverse this cycle.
Exercise and diet tips
If a doctor diagnoses somone with diabetes, they will oftenTrusted Source recommend
making lifestyle changes to support weight management and overall health.
A doctor may refer a person living with diabetes or prediabetes
to a nutritionist. A specialist can help people living with diabetes lead an
active, balanced lifestyle and manage the condition.
Steps a person can take to stay healthy with diabetes include:
- Eating a diet high in fresh, nutritious foods,
including whole grains, fruits, vegetables, lean proteins, low-fat dairy,
and healthy fat sources, such as nuts.
- Avoiding high-sugar foods that provide empty calories or
calories that do not have other nutritional benefits, such as sweetened
sodas, fried foods, and high-sugar desserts.
- Refraining from drinking excessive amounts of alcohol
or keeping intake to less than one drink a day for females or two drinks a
day for males.
- Engaging in at least 30 minutes of exercise per day on
at least 5 days of the week, such as walking, aerobics, riding a bike, or
swimming.
- Recognizing signs of low blood sugar when exercising,
including dizziness, confusion, weakness, and profuse sweating.
Some people can also take steps to reduce their body mass index (BMI) if needed, which can help those
with type 2 diabetes manage the condition without medication.
Using insulin
All people living with type 1 diabetes and some people living
with type 2 diabetes need to administer insulin to keep
their blood sugar levels from becoming too high.
Various types of insulin are available, and most are grouped by
how long their effect lasts. There are rapid-acting, short-acting,
intermediate-acting, long-acting, and mixed insulins.
Some people will use long-acting insulin to maintain
consistently low blood sugar levels. Others may use short-acting insulin or a
combination of insulin types. Whatever the type, a person will usually check
their blood sugar levels to determine how much insulin they need.
To check blood sugar levels, a person can use a blood glucose
monitor, which involves pricking their skin, or a combination of a continuous
blood glucose monitor (CGM) and skin pricks.
A CGM takes blood sugar readings regularly throughout the day.
They can help a person make any adjustments to their medications.
Self-monitoring is the only way a person can find out their blood sugar levels. Assuming the level from any physical symptoms that occur may be dangerous unless a person suspects extremely low sugar and thinks they need a rapid dose of glucose.
How much is too much?
Insulin helps people living with diabetes live an active
lifestyle. However, it can lead to serious side
effects, especially if a person administers too much.
Excessive insulin can cause hypoglycemia,
or extremely low blood sugar, and lead to nausea, sweating, and shaking.
It is essential that people measure insulin carefully, adjust
their medications based on their needs, and eat a consistent diet that helps to
balance blood sugar levels as much as possible.
Other medications
In addition to insulin, other types of medication are available
that can help people manage their condition.
Metformin
A doctor may prescribe metformin in pill form to a person with
type 2 diabetes.
It contributes to:
- lowering blood sugar
- making insulin more effective
People living with diabetes may also have other health risks,
which they may also need medication to control. A doctor will advise the
individual about their needs.
SGLT2 inhibitors and GLP-1 receptor agonists
In 2018, new guidelines
also recommended prescribing additional drugs for people with:
- atherosclerotic cardiovascular disease
- chronic kidney disease
These are sodium-glucose cotransporter 2 (SGLT2) inhibitors or
glucagon-like peptide-1 (GLP-1) receptor agonists.
For those with atherosclerotic cardiovascular disease and a high
risk of heart failure, the guidelines advise doctors to prescribe
an SGLT2 inhibitor.
GLP-1 receptor agonists work by increasing the amount of insulin the body produces
and decreasing the amount of glucose that enters the bloodstream. It is an
injectable medication. People may use it with metformin or alone. Side effects
include gastrointestinal problems, such as nausea and a loss of appetite.
SLGT2 inhibitors are a new typeTrusted Source of drug for lowering blood sugar levels. They work separately from insulin, and may be useful for people who are not ready to start using insulin. People can take it by mouth. Side effects include a higher risk of urinary and genital infections and ketoacidosis.
Self-monitoring tips
Self-monitoring blood sugar levels is vital for effective diabetes managementTrusted Source,
helping to regulate meal scheduling, physical activity, and when to take
medication, including insulin.
While self-monitoring blood glucose machines vary, they will
generally include a meter and test strip for generating readings. It will also
involve using a lancing device to prick the skin for obtaining a small quantity
of blood.
Precautions
People should refer to the specific instructions of a meter in
every case, as machines will differ. However, the following precautions
and steps will apply to many devices on the market:
- Making sure both hands are clean and dry before
touching the test strips or meter.
- Using a test strip once only and keeping them in their
original canister to avoid any external moisture changing the result.
- Keeping canisters closed after testing.
- Checking the expiration date before use.
- Checking whether the machine requires coding before
use, which may apply to older varieties
- Storing the meter and strips in a dry, cool area.
- Taking the meter and strips to consultations so that a
primary care physician or specialist can check their effectiveness.
Tips
People checking their blood sugar levels with a blood glucose
meter will also use a device called a lancet to prick their finger. While the
idea of drawing blood might cause distress for some people, lancing the skin to
obtain a blood sample should be a gentle, simple procedure. Many meters require
only a teardrop-sized sample of blood.
A person may also find the following tips
useful:
- Using their fingertips to obtain a blood sample. While
some meters allow samples from other test sites, such as the thighs and
upper arms, the fingertips or outer palms produce more accurate results.
- Cleaning their skin with soapy, warm water to avoid
food residue entering the device and distorting the reading.
- Choosing a small, thin lancet for maximum comfort.
- Adjusting the lancet’s depth settings for comfort.
- Taking blood from the side of their finger, as this
causes less pain. Using the middle finger, ring finger, and little finger
may be more comfortable.
- Teasing blood to the surface in a “milking” motion
rather than placing pressure at the lancing site.
- Following local regulations for disposing of sharp
objects, including lancets.
While remembering to self-monitor involves people making lifestyle adjustments, it need not be an uncomfortable process.
