Some call it “the sugar” or “sugar diabetes.” Still, the actual word for the set of metabolic illnesses that cause your blood glucose (sugar) level to be excessively high, according to the Cleveland Clinic, is diabetes mellitus, or diabetes for short.
It is not caused by consuming too much sugar in and of itself but rather by how your body manages the sugar you ingest and what you do to control the amount of sugar in your blood.
According to the Centers for Disease Control and Prevention, more than 34.2 million individuals in the United States — 10.5 percent of the population — had some diabetes in 2018. (CDC). In 2017, it was the sixth most significant cause of death. According to the World Health Organization, more than 422 million people worldwide had diabetes in 2014. (WHO)
Diabetes Mellitus Types and Prevalence Defined
Diabetes encompasses a multitude of illnesses, which are often classified by type. Each variety differs in terms of what causes it, how it is treated, and the consequences that might occur.
Here’s a brief rundown of each form of diabetes: definitions, basic statistics, and how widespread each type is in the United States and globally.
Prediabetes and Insulin Resistance
Prediabetes is a prediabetic condition that may progress to type 2 diabetes. To understand what causes it, you must first understand how the body turns sugar (or glucose) into energy.
The body mainly absorbs glucose via the foods and drinks we ingest. The pancreas produces insulin, a hormone that allows glucose in your blood to reach your muscles, fat, and liver to be utilized as energy. When your body does not use insulin efficiently, your pancreas generates more insulin at first to overcome this resistance. However, if your pancreas cannot keep up with demand, the outcome is hyperglycemia, or high blood glucose levels, according to the American Diabetes Association (ADA).
The primary cause of prediabetes is insulin resistance. However, the origins of insulin resistance are unknown. According to the National Institute of Diabetes and Digestive and Kidney Diseases, established risk factors include family history, advanced age, excess weight, and a sedentary lifestyle (NIDDK).
In 2018, 88 million individuals in the United States had prediabetes, accounting for over one-third of the population. It is an age-related disorder that affects approximately half of all persons over 65. According to the Cleveland Clinic, a person with prediabetes has a 50% probability of acquiring diabetes within ten years.
According to Patricia Happel, DO, an associate professor and the associate medical director at the New York Institute of Technology College of Osteopathic Medicine in Old Westbury, New York, it is possible to get your blood glucose level back within normal range by making lifestyle changes such as eating a healthier diet, eating smaller, more frequent meals to keep your blood sugar stable, and exercising more. According to the ADA, decreasing only 7% of your body weight (or 15 pounds if you weigh more than 200 pounds) will reduce your chance of acquiring type 2 diabetes by 58%.
Type 2 Diabetes
As previously stated, insulin resistance is the root cause of type 2 diabetes. (1) Type 2 diabetes accounts for 90 to 95 percent of all diabetes cases, and roughly one in every five persons who have it are unaware that they have it.
The illness often occurs in adults over t5 and is more frequent in Asian, Black, and Hispanic people in the United States. It’s also closely linked to being overweight. According to the 2020 National Diabetes Statistics Report, around 89 percent of adults with diabetes are overweight or obese. However, tmostoverweight persons do not acquire type 2 diabetes. According to aallup-Healthways research, around 2 in 10 overweight individuals and 4 in 10 obese adults in the United States develop diabetes by their mid-to late-seventies.
Dietary and lifestyle modifications may treat type 2 diabetes to reduce blood glucose levels and weight. Furthermore, many persons with the illness frequently check their blood glucose levels, take oral or injectable medicines, and sometimes use insulin through a pen, pump, or needle. (2)
Type 2 diabetes, if left untreated or poorly managed, may cause a slew of health problems, some of which are fatal. According to MedlinePlus, they include hypoglycemia (low blood sugar); diabetic neuropathy (nerve damage) that causes pain or numbness; foot and limb injuries, diabetic ulcers, deformities, or even amputations; kidney disorders; heart disease; blindness; skin problems; digestive disorders; sexual dysfunction; problems with teeth and gums; and problems regulating blood pressure.
Type 1 Diabetes
Type 1 diabetes is an autoimmune illness in which the body’s immune system targets and kills the beta cells that produce insulin in the pancreas. Hyperglycemia arises in the absence of such hormones. Type 1 diabetics must take insulin injections to replace the insulin their bodies can not produce, andcheck their blood glucose levels regularly.
Type 1 diabetes affects roughly 5% of all diabetics in the United States, with non-Hispanic white persons having a greater frequency than other ethnic or racial groupings.
According to the ADA, this kind of diabetes may develop at any age. However, it is more common in childhood or early adulthood, which is why it was formerly referred to as juvenile diabetes. Type 1 diabetes, unlike prediabetes, is a chronic condition, according to MedlinePlus. A person with it may live everyday life with appropriate treatment. Nonetheless, according to a June 2016 research published in Diabetologia, the average life expectancy of a person with type 1 diabetes is 12 years lower than the general population, indicating that you must keep on top of your treatment regimen if you have this kind of diabetes. It’s also worth looking for advancements in type 1 management technologies, which might assist bin boosting lifespan rates in the future.
Complications of type 1 diabetes are comparable to those of type 2 diabetes because continuously increased blood sugar causes long-term harm in both situations. People with type 1 diabetes, on the other hand, are predisposed to a potentially fatal complication known as diabetic ketoacidosis (DKA). When tinsufficient insulin turnsglucose into energy, the body starts to break down fat for fuel. As a consequence, acids known as ketones accumulate in the circulation.
“We usually warn patients that if their blood sugar is higher than 250 [milligrams per deciliter; mg/dL], they should test their urine for the presence of ketones — or check if they are planning to exercise and their blood sugar is higher than 300 mg/dL.” “High amounts of ketones in your blood may make your blood overly acidic, which can be life-threatening,” explains Jordana Turkel, RD, a certified diabetes care and education expert (CDCES) at Park Avenue Endocrinology and Nutrition in New York City.
Fruity breath is a byproduct of DKA. Other symptoms include nausea, difficulty breathing, and loss of consciousness. DIfleft untreated, mDKA ay cause renal failure, fluid accumulation in the brain, cardiac arrest, and even death. In many cases, hospitalization is necessary to treat the disease with insulin, fluids, and other medications. However, DKA may be avoided by careful insulin administration and monitoring of ketones in the urine, which can be done simply at home with an over-the-counter diagnostic kit, according to MedlinePlus.
Gestational Diabetes
Pregnant women often acquire some insulin resistance to ensure enough glucose is available to give energy to a developing baby. Most of them do not progress to gestational diabetes, although according to MedlinePlus, this syndrome occurs in up to 14% of all pregnancies in the United States.
Treatment for gestational diabetes often includes dietary and lifestyle adjustments, but physicians may also prescribe oral diabetic medicines or insulin to help manage symptoms. (3)
Gestational diabetes may cause issues that harm the mother’s health, such as elevated blood pressure during pregnancy, known as preeclampsia. Furthermore, the syndrome may cause kids to be delivered prematurely or with larger-than-normal birth weight, leading to problems during delivery. Soon after delivery, the neonates might suffer dangerously low blood sugar levels. They are more likely to acquire obesity, heart disease, and type 2 diabetes later in life. (4)
Gestational diabetes typically resolves after the kid is delivered, but according to the CDC, half of all women with the illness will acquire type 2 diabetes.
Type 1.5 Diabetes
Adults with latent autoimmune diabetes are occasionally referred to by this moniker (LADA). According to Beyond Type 1, LADA is characterized by gradual pancreatic beta cell loss comparable to type 1 diabetes, except it is often slower and develops later in life.
“If you have a patient over the age of 30 who comes in with typical symptoms — the blood sugar is very high — they may be able to control some of their symptoms if you give them metformin.” “However, during the following five years, the beta cells that produce insulin will cease functioning, and they will become a real type 1 diabetic needing insulin,” explains Turkel.
According to an ADA article published in 2016, a precise LADA diagnosis is critical so that beneficial therapies, such as the insulin therapy they will ultimately need, are not postponed in favor of oral drugs suited for type 2 diabetes.
In general, clinicians diagnose LADA by looking for antibodies in pancreatic cells. A C-peptide test, which measures insulin synthesis, may also aid in the diagnosis. (5)
Type 3 Diabetes
Unlike the other kinds of diabetes, so-called type 3 diabetes is not a medically recognized diagnosis. According to the Mayo Clinic, it is a study phrase that refers to evidence that Alzheimer’s disease and other neurodegenerative disorders are associated with insulin resistance in the brain.
Insulin influences brain cell metabolism and how brain cells communicate with the body for diverse purposes. According to a May 2016 paper published in Molecular Basis of Disease, the hormone also helps control blood flow to the brain and other regions of the body.
According to JPND Research, research into “type 3 diabetes” looks at how various disruptions in insulin action may disrupt blood flow or cause abnormal protein accumulations that lead to brain cell death and conditions such as cognitive impairment, dementia, Parkinson’s disease, and Alzheimer’s disease.
RELATED: The Diabetes Freedom program on the Official Website.
Diabetes Signs and Symptoms
If you feel you have prediabetes or diabetes due to any of the symptoms listed below, you should see your doctor right once.
Regardless of the kind of diabetes mellitus, the symptoms are lessentiallythe same. They are as follows: (6)
- heightened thirst
- heightened hunger (especially after eating)
- Mouth dryness
- Urination occurs often.
- Unknown cause of weight loss
- Fatigue
- Vision hazard
- Numbness or tingling sensations in the hands or feet
- Cuts and sores that heal slowly or not at all
- Skin that is dry and itchy (usually in the vaginal or groin area)
- Yeast infections are common.
How Is Diabetes Diagnosed?
You must visit your healthcare provider’s office to get tested for prediabetes or diabetes. Unfortunately, there is no way to test for the condition at home. The healthcare professional will collect a medical history as a first step in diagnosing you, including information about aanyonein your family who has had diabetes and what kind. Following that, they will most likely request lab tests to monitor your blood glucose levels, such as:
Fasting plasma glucose measurement (FPG) This test is administered following an eight-hour fast with no food and just short sips of water. The following are the implications of the findings:
- Less than 100 mg/dL is considered normal.
- Diabetes mellitus: 100–125 mg/dL
- Diabetes is a blood sugar level of 126 mg/dL or greater.
A1C test for hemoglobin This test measures how much glucose binds to hemoglobin in your red blood cells throughout the last three months. It is not necessary to fast before taking it. The following are the implications of the findings: (7)
- Less than 5.7 percent is considered normal.
- Prediabetes affects 5.7–6.4% of people.
- Diabetes has a prevalence of 6.5 percent or higher.
Test for oral glucose tolerance (OGTT) While several glucose challenges or tests are available, an OGTT is a typical method. You will fast overnight before having your blood collected after drinking a glucose-containing beverage, and your blood will be analyzed one, two, and three hours later. (8)
- Less than 140 mg/dL is considered normal.
- Diabetes mellitus: 140–199 mg/dL
- Diabetes: a blood sugar level of 200 mg/dL or higher
Plasma glucose test at random (RPG) This diabetes test does not need fasting beforehand, and although values of 200 mg/dL or more might indicate diabetes, it is not often utilized.
Other tests that may be conducted, according to the JDRF and the NIDDK, include: (9)
Autoantibody tests are most commonly used to diagnose type 1 diabetes or LADA. Typical tests seek antibodies that target insulin or specific pancreatic cells.
The C-peptide test detects a protein that reflects the amount of insulin in the body. Low levels might be an indication of type 1 diabetes or LADA.
Monogenic types of diabetes, such as maturity-onset diabetes of the young and neonatal diabetes mellitus, may be genetically tested.
Diabetes Causes and Risk Factors
You may tmakeefforts to reduce your risk of developing insulin-resistant diabetes, such as prediabetes, type 2 diabetes, or gestational diabetes. (It is unknown if type 1 diabetes, an autoimmune illness in which too little or no insulin is generated, is avoidable.)
Diabetes Risk Factors Under Your Control
The most significant risk factors for developing insulin resistance are within your power to change. They are as follows:
- Excess weight, particularly a BMI of 25 or higher for most ethnic groups in the United States, 23 or higher for Asian Americans, and 26 or higher for Pacific Islanders
- A high-fat, added-sugar, and refined-carbohydrate diet
- There is no regular exercise.
- Tobacco smoking
A balanced diet low in refined carbs and a workout program, according to the NIDDK, are behaviors you may adopt to reduce your chances of developing insulin resistance. (10) According to the CDC, quitting smoking may also help.
According to the NIDDK, high blood pressure, a low level of HDL (“good”) cholesterol, a high level of triglycerides, and heart disease are all risk factors that may be controlled by adopting sensible dietary and lifestyle choices, as well as taking medication when recommended. You may be unable to avoid depression, another risk factor, but you can sindeedmanage it. (11)
Diabetes Risk Factors You Can’t Control
Other risk factors, however, are beyond your control, such as: (12)
- 45 years old or older
- Diabetes runs in the family
- ethnicity of African Americans, Alaska Natives, American Indians, Asian Americans, Hispanic/Latino, Native Hawaiians, or Pacific Islanders
- A history of gestational diabetes or a kid weighing nine pounds or more at delivery
- Polycystic ovary syndrome (PCOS)
People should be aware that they can take steps to reduce their risk of developing insulin-resistant diabetes. Still, they should not feel guilty if they develop the disease anyway, according to Joshua D. Miller, MD, the medical director of diabetes care at Stony Brook Medicine in Stony Brook, New York, who manages a personal diagnosis of type 1 diabetes.
“No one wakes up wanting to have diabetes, whether type 1 or type 2.” “Developing diabetes is absolutely beyond most people’s control — even along the type 2 diabetes spectrum, where lifestyle and weight play a significant influence in disease development,” Dr. Miller explains. “Getting over the idea that you’ve done something wrong because your blood sugar is too high is perhaps the most difficult hurdle to cross to assist individuals to become better at controlling their diabetes.”
To learn more about George’s story, click here to visit the Diabetes Freedom website.
Is Diabetes a Hereditary Disease? The Impact of Genetics on Risk
Diabetes can run in families, and scientists have found genes linked to different kinds of illnesses. Diabetes may be monogenic, which means that a single gene can be identified and tested for, or polygenic, which means that numerous genes are involved, as well as a complicated interplay with lifestyle and environmental risk factors. (13)
Polygenic Diabetes
Polygenic illnesses include type 1 and type 2 diabetes and gestational diabetes. (14) While no specific gene mutation causes them, there is a burgeoning area of testing known as a polygenic risk score. According to research published in Genetics in Medicine in August 2016, polygenic risk scoring looks at common genetic variants known as single nucleotide polymorphisms (SNPs) connected with your risk of acquiring diabetes.
While your risk score cannot predict whether you will develop a polygenic form of diabetes with 100 percent certainty, it can help you focus on taking preventive measures, according to Mónica Alvarado, a certified and licensed genetic counselor and regional administrator for genetic services at Kaiser Permanente in Pasadena, California. “The benefit of this is that someone may be more motivated to regulate their food and exercise, as well as test their glucose and hemoglobin A1C more often, than if they just know their risk for diabetes is greater than the typical person.”
Alvarado further claims that the effect of family history is complicated, and it’s difficult to tell if relatives share genetic variants or food, lifestyle, and environment that predisposes them to diabetes.
In the case of gestational diabetes, many women who acquire the illness have at least one close family member with the condition or type 2 diabetes, such as a parent or sibling. (15)
Monogenic Diabetes
Monogenic diabetes accounts for between 1% and 4% of all diabetes cases. Maturity-onset diabetes of the young (MODY), which generally emerges in teenagers and young adults, and neonatal diabetes mellitus (NDM), which is most frequent in newborns and babies, are two of the most common types. (16)
Some variants of MODY cause modestly elevated blood sugar levels that stay steady throughout life, with no or mild symptoms and no problems. Other kids may need insulin or a family of oral drugs known as sulfonylureas, which boost insulin release from beta cells. (17) According to MedlinePlus, the most prevalent MODY mutations are identified in the GCK or HNF1A genes.
NDM infants do not manufacture enough insulin. The illness is sometimes confused with type 1 diabetes. Babies with NDM are born smaller and develop slower than their contemporaries who do not have the condition. About half of the newborns with NDM will have it for the rest of their lives; the other half will lose it, though it may recur later. Most NDM testing focuses on three genes: KCNJ11, ABCC8, or INS. (18)
Diabetes Treatment and Medication Options
If you’ve been diagnosed with diabetes, your treatment plan will be tailored to your specific needs and the kind of diabetes you’re dealing with. However, one term that is often associated with the disease is insulin.
Insulin
According to MedlinePlus, insulin treatment is self-administered by injection, up to multiple times per day, using a needle, syringe, pen, or pump.
Two forms of insulin are often utilized to get you through the day.
Basal insulin is present in the body 24 hours a day, regardless of what or when you consume it. “It’s what the pancreas would be continually flowing into the system,” explains Grace Derocha, a registered dietitian and certified diabetes care and education expert at Blue Cross Blue Shield of Michigan in Detroit.
Long-acting insulin, such as Detemir (Levemir), Tresiba (degludec), Lantus, Toujeo, and Basaglar (glargine), intermediate-acting insulin, such as Humulin N (isophane), Novolin N, and Lente (lente), is released slowly into the circulation and may last up to 24 hours. According to Derocha, if someone is on a pump, the quantity is modified slightly based on their degree of activity or whether they are awake or sleeping.
The quantity of insulin administered to cover the glucose from eating is referred to as a bolus or mealtime insulin. The amount of bolus insulin you need is determined by your meal size. According to Diabetes.co.uk and the ADA, fast-acting insulins such as NovoLog (insulin aspart), Apidra (insulin glulisine), and Humalog (insulin lispro) that are given before a meal function within 15 to 30 minutes and last for many hours.
Oral Medications
Various oral drugs are used to treat diabetes instead of or in addition to insulin, especially in patients whose bodies still produce some insulin.
Metformin (brand names Glucophage XR, Fortamet, and Glumetza) is the first-line therapy for type 2 diabetes and is also used to treat prediabetes and gestational diabetes. According to MedlinePlus, it belongs to the Biguanide family of medicines and helps to manage blood sugar by reducing the release of glucose from the liver and improving insulin resistance. Long-term usage has been linked to vitamin B12 insufficiency. Hence the ADA recommends that B12 levels be checked regularly.
Other oral diabetic drugs, according to the Joslin Diabetes Center, include:
Sulfonylureas, This family of medications includes Glucotrol (glipizide) and Amaryl (glimepiride), which stimulate the pancreas to produce more insulin when taken with meals.
Meglitinides Prandin (repaglinide) is a meglitinide that, when taken with meals, stimulates the pancreas to produce more insulin.
Thiazolidinediones Actos (pioglitazone), the solely licensed medicine in this class, makes the body more sensitive to the effects of insulin.
Inhibitors of DPP-4 This class includes Januvia (sitagliptin) and Tradjenta (linagliptin). These medications increase the amount of insulin produced after a meal and assist in lowering the quantity of glucose produced by the body.
Victoza (liraglutide), Trulicity (dulaglutide), and Ozempic (semaglutide) are GLP-1 receptor agonists that replicate the actions of the incretin hormone GLP-1, which is excreted following a meal and decreases blood sugar.
Invokana (canagliflozin) belongs to the family of SGLT2 inhibitors, which cause the kidneys to excrete more glucose via urine.
Glucose Testing
Glucose monitoring is one of the most effective techniques for managing diabetes or prediabetes. It is possible to test your glucose levels at home using a glucose monitor or meter, which analyzes a drop of blood drawn by pricking your finger with a lancet and then depositing the blood drop on a disposable test strip placed into the meter. Consult your doctor to set blood glucose levels goals, but keep in mind that blood glucose for an adult without diabetes should be less than 100 mg/dL before meals and fasting and less than 140 mg/dL two hours after meals (called postprandial glucose), according to the US Food and Drug Administration (FDA).
Continuous glucose monitors, such as the Freestyle Libre, Dexcom G6, and Medtronic Guardian, are available to wear on your arm or belly for 10 to 14 days.
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Tips for Keeping Blood Sugar Under Control Through Diet and Lifestyle
Depending on the kind of diabetes you have, you will need to collaborate with your healthcare team to develop a diet and lifestyle plan that is tailored to your specific requirements. Then you’ll need to assemble a support group within and outside the family to assist you to remain on track.
Eating to Control Your Blood Sugar
As with any healthy diet and lifestyle, you should concentrate on consuming whole, fresh foods high in fiber while limiting your consumption of processed foods high in salt, sugar, saturated fat, and dangerous trans fat. According to the NIDDK, you’ll probably have to cut down on the carbs (primarily sugars and starches) you eat, especially in sugary beverages like juice, soda, and sports or energy drinks. Carbohydrates, including dietary fiber, may and should remain a component of your diet with the right balance and lesser quantities.
Carbohydrate Counting
Derocha explains, “We aim to teach carb management, uniformity, and counting.” “I refer to it as the ‘three carbohydrate Cs,’ which are essential for any form of diabetes and blood sugar management.” In brief, counting your carbs and keeping them constant at each meal will help you stabilize and regulate your blood sugar.
Finally, you should see your primary care doctor or a trained dietitian to determine how many carbohydrates you should consume each day since they will take any insulin or medicine you’re taking into consideration. However, according to the CDC, the recommended carbohydrate consumption for most persons with diabetes is now about 50% of the total calories ingested.
Glycemic Load and Glycemic Index
Some individuals additionally consider how certain carbohydrate-containing meals are likely to boost their blood sugar based on the food’s rank on the glycemic index (GI) and its glycemic load (GL).
The glycemic index measures how quickly a food increases blood glucose levels. Foods are rated from 0 to 100, with 100 being pure glucose (sugar). Low-GI meals have a GI of 55 or less (for example, oatmeal, sweet potatoes, and most fruits); medium-GI foods have a GI of 56–69 (for example, brown rice and maize); and high-GI foods have a GI of 70 or more (for example, bagels, popcorn, and melon).
“A meal with a high glycemic index will elevate blood sugar higher than a dish with a medium or low glycemic index,” Derocha adds. “The glycemic load itself is a better method to inform you how that specific item will then affect your blood sugar,” she says. This is because glycemic load compares the capacity of the same quantity of carbohydrates in each diet to elevate blood sugar levels.
To calculate a food’s glycemic load, multiply its GI by the carbohydrate grams (g) in a serving and divide by 100.
Low-GL foods are ranked 1–10, medium-GL foods are ranked 11–19, and high-GL foods are rrated20 or above. According to the Oregon State University Linus Pauling Institute Micronutrient Information Center, although 1 cup of watermelon has a high GI of 76, it has a low GL of 8. (19)
Knowing a food’s exact GL may help you lower and regulate your blood sugar, but Derocha emphasizes that this method works best when combined with carb tracking and an intelligent diet.
Diabetes and the Ketogenic Diet
Some patients with type 2 diabetes will follow a ketogenic diet (commonly known as the “keto“), a high-fat, low-carb plan that causes your body to burn fat for fuel rather than carbohydrates. Because the diet is so low in carbs, the body soon depletes its glucose stores and enters a natural state of ketosis, in which the liver breaks down fat into acids known as ketones, which become the primary fuel source. “A variation of the ketogenic diet may assist type 2 individuals on medication or who have PCOS with insulin resistance,” adds Turkel, “especially if decreasing weight is a goal.”
However, she adds, persons with insulin resistance often attempt to manage some dietary and lifestyle modifications simultaneously to help regulate their blood sugar, so she does not endorse the rigors of a ketogenic diet as a long-term solution. Furthermore, if you use oral diabetic drugs, you may be at risk of potentially significant consequences such as hypoglycemia.
Eating to Control Gestational Diabetes
“The first line of therapy is diet and exercise, followed by regular blood sugar monitoring,” explains Derocha. “When a woman has gestational diabetes, we normally have her blood sugar checked four to six times daily.” If that is insufficient, insulin, rather than oral medicines, is the recommended course of therapy.
Derocha’s personal experience with gestational diabetes has shown that it is manageable. “I didn’t have to take any medication or insulin throughout my pregnancy since I was able to manage it with food and lifestyle modifications.”
The Importance of Exercise
According to the ADA, the importance of exercise in blood sugar control cannot be emphasized. “When we exercise, we utilize sugar, or blood glucose, as our initial source of energy,” Derocha adds. As blood glucose levels fall, “your body will extract part of the glycogen reserves, which is excess blood sugar stored in your cells, to utilize as energy.” Furthermore, “when we have greater lean muscle mass, we are less insulin resistant,” explains Derocha.
Regarding fitness, Happel recommends picking an activity you like and sticking with it. “Make it enjoyable, something you love doing,” Happel advises. “Do it at home, do it at work.” If you like dancing, then do so. Be active by going on a walk or working in the garden.”
Keep frequency in mind as well. The U.S. Department of Health and Human Services (HHS) suggests 30 minutes of moderate to strenuous exercise at least five days per week, but consult with your healthcare team first to determine the best approach to start. (20)
If you have diabetes-related nerve damage in your feet or legs, you may need to make certain adjustments to exercise safely. “Diabetics, particularly if they have neuropathy [nerve damage] or are at risk for it, should see a podiatrist, especially if they are elderly or unable to reach their toes and feet,” adds Derocha. For exercising, you may need to purchase specific shoes or compression stockings. According to the ADA, keep your feet and toes clean and examine them before and after exercise for any cuts or cracks in the skin.
Diabetes Complications
Regardless of the kind of diabetes you have, poorly regulated blood sugar may lead to significant and even life-threatening health consequences. However, there are specific distinct health hazards associated with each variety that you should be aware of.
Prediabetes
The primary issue of prediabetes is that if left untreated, insulin resistance may progress to type 2 diabetes. The good news is that you may still correct this illness by eating a healthy diet and exercising — and, if you are overweight, by decreasing even a minor amount of weight. (21) Miller informs patients that no matter how much weight they need to shed to reach their optimal body weight, “if you drop 5 pounds or even 10 pounds, your numbers will substantially improve.”
Furthermore, prediabetic peripheral neuropathy, a kind of nerve loss that is a forerunner to the much more prevalent diabetic peripheral neuropathy, might occur. Excess hyperglycemia in the blood delays or changes the conductive characteristics of the nerves, causing electrical impulses to the neurons to malfunction. According to the Foundation for Peripheral Neuropathy, numbness, tingling, and burning sensations might occur, particularly in the feet and hands.
Type 1 and Type 2 Diabetes
Diabetes types 1 and 2 may cause various consequences if left uncontrolled or inadequately treated for an extended time. They are as follows:
- According to the NIDDK, blood vessel damage causes heart, stroke, and kidney disease. (22)
- Blindness is caused by swelling, nerve damage, or damage to the small blood vessels in the eye (including diabetic retinopathy, diabetic macular edema, cataracts, and glaucoma). (23)
- Bladder difficulties and sexual dysfunction might occur due to blood vessels or nerve injury. (24)
- According to Diabetes.co.uk, orthostatic hypotension (a dip in blood pressure upon standing up) is caused by nerve injury. (25)
- Slow-healing lesions caused by blood vessel damage (26)
- Diabetic ketoacidosis (DKA) is a buildup of acids known as ketones in the circulation that occurs when the body does not have enough glucose to utilize as fuel. (27)
Other Possible Complications of Diabetes
Diabetes mellitus is connected with a slew of problems. They are as follows:
Diabetes-related neuropathy Diabetes causes nerve damage in roughly 60% of persons. The most common kind of polyneuropathy is distal symmetric polyneuropathy (DSP). The most distal nerve fibers from the central nervous system fail first in this kind of neuropathy. “It generally begins in the feet; [you’ll] experience tingling or numbness at the bottom of the feet, and then [it] may gradually spread upward in the foot to the ankle and the legs,” Happel explains.
The pattern is generally symmetrical, affecting both sides’ limbs. A burning sensation may occur, which Happel notes is frequently misdiagnosed by patients as athlete’s foot. Numbness and eventually significant loss of feeling, as well as loss of reflexes, may develop over time.
People may believe they are getting better now that the pain is gone, but this is untrue. They become more prone to harm because they lack the signal of pdistressthat tells them when they have been injured and need care. This may result in further issues such as ulcers, sores, and the necessity for limb amputations. (28)
The initial step in treating diabetic neuropathy is to regulate blood sugar levels to avoid additional nerve damage. After that, pain medication, both over-the-counter and prescription, and electric nerve stimulation may be administered in certain situations. (29)
Amputations, Unfortunately, neuropathy issues, as well as poor wound healing, may lead to ulcers, gangrene (a potentially fatal illness caused by the death of damaged tissue), and bone infections severe enough to need an amputation. In the United States, more than 108,000 diabetics were released from the hospital after undergoing a lower-extremity amputation in 2014.
According to MedlinePlus, if gangrene is detected in time, physicians may treat it with antibiotics, surgery, and oxygen treatment. Similarly, medications and surgery may be used to treat a bone infection, according to MedlinePlus. The best cure, however, is prevention. Inspect your feet and any other locations where you have skin issues or nerve damage daily. Even if the cracks, abrasions, or sores don’t pain, a medical practitioner should treat them immediately. (30)
Charcot’s neuropathic osteoarthropathy This motor neuropathy, also known as Charcot neuropathy, occurs when joints in the foot cannot react effectively to force applied to them due to nerve signal disturbance. Injuries occur due to a lack of coordination, and the resultant inflammation may result in microfractures that increase over time and ruin the structural integrity of the feet and limbs. Charcot syndrome causes foot abnormalities and ankle dislocations. According to the American Orthopaedic Foot & Ankle Society, treatment focuses on stabilizing the damaged region (with a cast, for example), keeping too much weight off it, and minimizing swelling.
Hypoglycemia Although it may seem contradictory, diabetes may result in abrupt decreases in blood sugar, known as hypoglycemia. These reductions may occur when the insulin or another diabetes medicine is not administered at the appropriate amount for what you eat or your level of exercise. According to the NIDDK, it may also be triggered by a missed meal or one with insufficient carbs.
Jitteriness or shakiness, blurred vision, weariness, dizziness, disorientation, a rapid or irregular heartbeat, irritability, weakness, or severe hunger are all symptoms of hypoglycemia. Seizures and comas may happen from dangerously low blood sugar levels.
If you have any of these symptoms, check your blood glucose level, and if it is less than 70 mg/dL (or your agreed-upon target level), consume 15 grams of carbohydrates right away in the form of glucose pills, glucose gel, soda, or regular fruit juice (except orange juice if you have kidney disease, because the drink’s compromising potassium level can strain the kidneys), raisins, hard candies, or a tablespoon of honey or sugar. If the person cannot act for herself, someone else may have to administer a glucagon injection, which the individual should have in case of an emergency. Glucagon is a hormone that stimulates the liver to convert glycogen to glucose. (31)
The best method to prevent hypoglycemia is to routinely check your blood glucose level, eat meals with the necessary carbs at regular intervals, and be aware of any changes you may need to make in what you eat or how much insulin you take when you exercise. (32)
Nonketotic hyperglycemic hyperosmolar syndrome According to the Mayo Clinic, when your blood glucose level rises to dangerously high levels, especially over 600 mg/dL, a life-threatening disease known as a hyperglycemic hyperosmolar nonketotic syndrome (HHNS) may develop. The body will attempt to expel the additional blood glucose in the urine, resulting in severe dehydration and an electrolyte imbalance. Consequently, the brain may enlarge, irregular heart rhythms may occur, and seizures, comas, organ failure, or even death may occur.
According to Happel, one cause of HHNS is noncompliance with insulin treatment regimens, particularly among type 1 diabetic youth and college students. “They don’t want to stand out from their peers, so they don’t take their insulin.” They then head out for some beers. When alcohol is broken down in the body, it is also broken down into sugars. “However, since they are not taking their insulin, they end up in the hospital,” Happel continues.
However, anybody with diabetes, regardless of type, is at risk for this problem, mainly if they are insulin-dependent. Noncompliance isn’t the primary cause of HHNS; occasionally, a person gets HHNS while battling another condition that has debilitated and dehydrated them, according to Happel.
Treatment usually occurs in the intensive care unit (ICU). “Fluid resuscitation is one of the first things to do.” “By the time patients have these difficulties, they are four to six liters behind in fluid,” explains Happel. Insulin is given, and electrolyte balances are checked. The best method to prevent HHNS is to check your blood sugar levels, take any insulin or medicines as recommended, and keep to your diabetic diet and activity plan.
Complications of Gestational Diabetes
Preeclampsia (high blood pressure during pregnancy) is a frequent consequence of gestational diabetes that may necessitate an early birth. According to the American College of Obstetricians and Gynecologists, full-term infants delivered to moms with gestational diabetes may weigh nine pounds or more, which can cause problems during delivery and increase the risk of cesarean surgery.
Infants are also more likely to experience critically low blood sugar, jaundice, or respiratory issues after birth. Later in age, the kids are more likely to acquire obesity and heart disease. The mother and the kid are at a higher risk of getting type 2 diabetes. Diet and lifestyle changes are often suggested to keep gestational diabetes under control and reduce the risk of complications. (33)
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