Diabetes
`
`Overview
`
`Diabetes mellitus refers to a group of diseases that affect how the body uses blood sugar (glucose). Glucose is an important source of energy for the
`cells that make up the muscles and tissues. It's also the brain's main source of fuel.
`
`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.
`Symptoms
`
`Diabetes symptoms depend on how high your blood sugar is. Some people, especially if they have prediabetes, gestational diabetes or type 2
`diabetes, may not have symptoms. In type 1 diabetes, symptoms tend to come on quickly and be more severe.
`
`Some of the symptoms of type 1 diabetes and type 2 diabetes are:
`
`Feeling more thirsty than usual.
`Urinating often.
`Losing weight without trying.
`Presence of ketones in the urine. Ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available
`insulin.
`Feeling tired and weak.
`Feeling irritable or having other mood changes.
`Having blurry vision.
`Having slow-healing sores.
`Getting a lot of infections, such as gum, skin and vaginal infections.
`
`Type 1 diabetes can start at any age. But it often starts during childhood or teen years. Type 2 diabetes, the more common type, can develop at any
`age. Type 2 diabetes is more common in people older than 40. But type 2 diabetes in children is increasing.
`When to see a doctor
`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.
`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.
`Causes
`
`To understand diabetes, it's important to understand how the body normally uses glucose.
`How insulin works
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`Insulin is a hormone that comes from a gland behind and below the stomach (pancreas).
`
`The pancreas releases insulin into the bloodstream.
`The insulin circulates, letting sugar enter the cells.
`Insulin lowers the amount of sugar in the bloodstream.
`As the blood sugar level drops, so does the secretion of insulin from the pancreas.
`The role of glucose
`Glucose — a sugar — is a source of energy for the cells that make up muscles and other tissues.
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`Glucose comes from two major sources: food and the liver.
`Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
`The liver stores and makes glucose.
`When glucose levels are low, such as when you haven't eaten in a while, the liver breaks down stored glycogen into glucose. This keeps your
`glucose level within a typical range.
`
`The exact cause of most types of diabetes is unknown. In all cases, sugar builds up in the bloodstream. This is because the pancreas doesn't produce
`enough insulin. Both type 1 and type 2 diabetes may be caused by a combination of genetic or environmental factors. It is unclear what those factors
`may be.
`Risk factors
`
`Risk factors for diabetes depend on the type of diabetes. Family history may play a part in all types. Environmental factors and geography can add to
`the risk of type 1 diabetes.
`
`Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes immune system cells (autoantibodies). If you have
`these autoantibodies, you have an increased risk of developing type 1 diabetes. But not everyone who has these autoantibodies develops diabetes.
`
`Race or ethnicity also may raise your risk of developing type 2 diabetes. Although it's unclear why, certain people — including Black, Hispanic,
`American Indian and Asian American people — are at higher risk.
`
`Prediabetes, type 2 diabetes and gestational diabetes are more common in people who are overweight or obese.
`Complications
`
`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:
`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.
`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.
`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.
`Alzheimer's disease. Type 2 diabetes may increase the risk of dementia, such as Alzheimer's disease.
`Depression related to diabetes. Depression symptoms are common in people with type 1 and type 2 diabetes.
`Complications of gestational diabetes
`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:
`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.
`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.
`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:
`Preeclampsia. Symptoms of this condition include high blood pressure, too much protein in the urine, and swelling in the legs and feet.
`Gestational diabetes. If you had gestational diabetes in one pregnancy, you're more likely to have it again with the next pregnancy.
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`Prevention
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`Type 1 diabetes can't be prevented. But the healthy lifestyle choices that help treat prediabetes, type 2 diabetes and gestational diabetes can also help
`prevent them:
`Eat healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains. Eat a variety to keep
`from feeling bored.
`Get more physical activity. Try to get about 30 minutes of moderate aerobic activity on most days of the week. Or aim to get at least 150 minutes
`of moderate aerobic activity a week. For example, take a brisk daily walk. If you can't fit in a long workout, break it up into smaller sessions
`throughout the day.
`Lose excess pounds. If you're overweight, losing even 7% of your body weight can lower the risk of diabetes. For example, if you weigh 200
`pounds (90.7 kilograms), losing 14 pounds (6.4 kilograms) can lower the risk of diabetes.
`
`But don't try to lose weight during pregnancy. Talk to your provider about how much weight is healthy for you to gain during pregnancy.
`
`To keep your weight in a healthy range, work on long-term changes to your eating and exercise habits. Remember the benefits of losing weight,
`such as a healthier heart, more energy and higher self-esteem.
`
`Sometimes drugs are an option. Oral diabetes drugs such as metformin (Glumetza, Fortamet, others) may lower the risk of type 2 diabetes. But healthy
`lifestyle choices are important. If you have prediabetes, have your blood sugar checked at least once a year to make sure you haven't developed type 2
`diabetes.
`
`By Mayo Clinic Staff
`
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