Diabetes is a metabolic disease, caused by no or too little insulin production that affects millions of Americans. As food is broken down by the intestines, glucose or sugar is released into the blood. In response, insulin is released from the pancreas to help move glucose into your cells. Extra glucose is stored within the liver, muscles, and fat cells. The more glucose in your blood, the more insulin the pancreas produces. In type 1 diabetes, the pancreas is no longer able to produce insulin, therefore glucose freely floats within the blood. In type 2 diabetes, either the pancreas is unable to produce enough insulin to control glucose levels or the body becomes less sensitive to the insulin produced.1
As of February 2020, 11.3% of North Carolina adults have been diagnosed with diabetes, with approximately 250,000 more individuals undiagnosed.2
Types of Diabetes1,3
Type 1 diabetes mellitus, formerly known as “insulin-dependent diabetes” or “childhood-onset diabetes” is caused by an autoimmune or viral destruction of the pancreatic beta-cells (the cells responsible for making insulin), typically caused by a genetic or environmental factor. This means that the pancreas is unable to produce any insulin. Beta-cell destruction can occur at different rates, affecting both adults and children and accounts for 5 to 10% of diabetes.
Type 2 diabetes mellitus accounts for 90 to 95% of diabetes and is caused by poor insulin production, rather than complete absence of insulin with type 1, or poor insulin response (insulin resistance). The exact reason this occurs is unknown, but being overweight, physically inactive, and making poor diet choices are key factors.
Individuals diagnosed with prediabetes are those that have blood glucose levels higher than normal, but not high enough to be considered “diabetic.” Prediabetes greatly increases your risk for both diabetes and cardiovascular disease and is typically seen in obese people with high cholesterol and high blood pressure.
Gestational diabetes is high blood sugar during pregnancy, in women without a history of diabetes. Uncontrolled gestational diabetes can lead to an extra large baby, a higher chance of C-section, or preeclampsia (high blood pressure during pregnancy). Women are routinely screened between weeks 24 and 28 of pregnancy to rule out diabetes.
Diabetes insipidus is a rare inherited disorder, affecting 1 in every 25,000 individuals, that causes the kidneys to produce large amounts of dilute and odorless urine. Typically the kidneys make 1 to 2 quarts of urine per day. With diabetes insipidus, the kidneys can produce 3 to 20 quarts daily. Diabetes insipidus is similar to diabetes mellitus because both cause polyuria or excessive urination, however patients with diabetes insipidus do not have trouble producing insulin and have normal blood glucose levels.
Each individual diagnosed with diabetes may experience different symptoms, however the three main indicators of high blood glucose are polyuria (frequent urination), polydipsia (excessive thirst), and polyphagia (excessive hunger). Other symptoms may include blurry vision, numbness or tingling in hands or feet, and slugginess or fatigue.
The A1c or hemoglobin A1c (HbA1c) test measures the amount of sugar attached to hemoglobin, a protein found in red blood cells that moves oxygen throughout the body. The higher your blood glucose, the more red blood cells become covered in sugar. A1c estimates your average blood glucose over 2 to 3 months and is measured with blood work or using a fingerstick A1c test. A normal A1c is less than 5.7%. Prediabetes is an A1c between 5.7 and 6.4%. Diabetes is diagnosed with an A1c greater than or equal to 6.5%.
The fasting plasma glucose (FPG) test determines the blood glucose level after not eating or drinking (except water) within at least 8 hours of testing, usually done first thing in the morning. Typically, blood glucose levels would be low if you are fasting since glucose comes from food breakdown. If you have diabetes, however, these levels may be high. A normal FPG is less than 100. Prediabetes is a FPG between 100 and 125. Diabetes is diagnosed with a FPG greater than or equal to 126. Testing blood glucose at any time is considered a random plasma glucose, which can also be used to diagnose diabetes.
The oral glucose tolerance test (OGTT) shows how well your body processes sugars by measuring your blood glucose before and 2 hours after drinking a sweet drink. This test is commonly used in pregnant women to help rule out gestational diabetes. A normal OGTT would be a blood glucose of less than 140, prediabetes 140 to 199, and diabetes greater than 200.
Diabetes Risk Factors6
Since type 1 diabetes is caused by an autoimmune reaction, risk factors for type 1 diabetes are not well understood. Known risk factors for type 1 diabetes, include a family history, since there may be a genetic link, and age. Type 1 diabetes can develop at any age, but there is a greater chance during childhood and early adulthood.
Risk factors for type 2 diabetes include a diagnosis of prediabetes, older age (45 years and older), obesity, and a sedentary or non-active lifestyle. Type 2 diabetes may also have a genetic link, increasing the risk for individuals whose parents or siblings have type 2 diabetes. African Americans, Hispanic/Latio Americans, American Indians, and Alaskan natives are typically at a higher risk.
Overtime, diabetes can cause complications throughout the body including the heart, blood vessels, nerves, eyes, and kidneys. High blood sugar, alongside high cholesterol, can clog blood vessels making it difficult for the heart to pump blood. This causes high blood pressure, which increases your risk of heart attack or stroke. High blood sugar can also damage nerves leading to neuropathies or a tingling, burning, or numbness in hands and feet. Diabetes increases risk for cataracts or glaucoma and if poorly controlled, blindness. Diabetes may also lead to irreversible kidney damage, requiring dialysis or kidney transplant.
Because in type 1 diabetes the pancreas is unable to make any insulin, the primary treatment for these individuals is insulin.
Treatment of type 2 diabetes is much more complex, with countless oral and injectable treatments, and typically depends on what works best for each individual. Oral medications work by increasing the amount of insulin released by the pancreas, decreasing glucose production, decreasing glucose absorption, increasing elimination of glucose, or improving the body’s response to insulin to lower blood sugar. Injectable medications work by increasing the amount of time you stay feeling full after eating, to help promote weight loss and by increasing insulin production. For patients with poorly controlled type 2 diabetes, insulin may also be used.
Gestational diabetes can often be controlled by eating healthy foods and exercising regularly, however some women may need insulin to lower their blood sugar.
Hypoglycemia Symptoms and Treatment10
Hypoglycemia or low blood sugar can be caused by certain diabetes medications, including insulin, or skipping a meal, and can cause seizures, unconsciousness, or even death, if left untreated. Blood sugar is considered low if less than 70 mg/dL, however symptoms may appear at higher values in some patients. Symptoms of low blood sugar may include sweating, shaking, hunger, or fatigue. When treating low blood sugar, we use the “15-15 Rule” — 15 grams of carbohydrates and recheck blood sugar after 15 minutes. It is important to consume simple sugars because your body absorbs these quickly and helps raise your blood sugar the fastest. This includes things like half a glass of orange juice or soda or 5 pieces of hard candy. There are also glucose tablets that can be purchased over-the-counter to help treat low blood sugar. You should inform your healthcare provider if you experience low blood sugars often.
Lifestyle changes are especially important for preventing or treating type 2 diabetes. Losing 5 to 10% of your body weight can lower your risk of developing diabetes by about 50%. The American Heart Association (AHA) encourages individuals with diabetes to exercise regularly and eat healthy. Adults need at least 150 minutes of moderate-intensity physical activity per week, with both aerobic and strength training exercises. Dietary changes may include portion control and limiting added sugars, fatty meats, saturated fats, sodium, cholesterol, and alcohol. A proper diabetic diet is rich in high-fiber whole grains, like oatmeal or brown rice, non-fried fish at least twice weekly, lean meats like skinless chicken or turkey, and fruits and vegetables. The AHA also promotes smoking cessation. Individuals with diabetes that smoke are three times as likely to die of cardiovascular death versus non-smokers and have a more difficult time controlling their blood sugar.
For more information and support, visit the American Diabetes Association (ADA) and Centers for Disease Control and Prevention (CDC) websites or talk with your doctor or pharmacist today.
By CaraBeth Harrison, PharmD, PGY1 Resident
- American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes. Diabetes Care [Internet]. 2020 [cited 2021 Jan 25]; 43(Suppl. 1): S14-S31. Available from: https://care.diabetesjournals.org/content/43/Supplement_1/S14.full-text.pdf.
- The Burden of Diabetes in North Carolina [Internet]. Arlington (VA): American Diabetes Association. 2020 Feb [cited 2021 Jan 25]. Available from: http://main.diabetes.org/dorg/docs/state-fact-sheets/ADV_2020_State_Fact_sheets_NC.pdf.
- Diabetes Insipidus [Internet]. Rochester (MN): Mayo Clinic. 2019 Feb 16 [cited 2021 Jan 25]. Available from: https://www.mayoclinic.org/diseases-conditions/diabetes-insipidus/symptoms-causes/syc-20351269.
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- Diabetes Risk Factors [Internet]. Atlanta (GA): Centers for Disease Control and Prevention. 2020 Mar 24 [cited 2021 Jan 25]. Available from: cdc.gov/diabetes/basics/risk-factors.html.
- Type 2 Diabetes [Internet]. Rochester (MN): Mayo Clinic. 2021 Jan 20 [cited 2021 Jan 25]. Available from: https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193.
- Basina M and Watson S. Everything You Need to Know About Diabetes [Internet]. Healthline; 2018 Oct 4 [updated 2020 Feb 26; cited 2021 Jan 25]. Available from: https://www.healthline.com/health/diabetes.
- Gestational [Internet]. Atlanta (GA): Centers for Disease Control and Prevention. 2020 Jul 14 [cited 2021 Jan 25]. Available from: https://www.cdc.gov/pregnancy/diabetes-gestational.html.
- Blood Sugar Testing and Control: Hypoglycemia (Low Blood Sugar) [Internet]. Arlington (VA): American Diabetes Association. [cited 2021 Jan 25]. Available from: https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hypoglycemia.
- Living Healthy with Diabetes. Dallas (TX): American Heart Association. 2020 Mar 12 [cited 2021 Jan 25]. Available from: https://www.heart.org/en/health-topics/diabetes/prevention–treatment-of-diabetes/living-healthy-with-diabetes.