Diabetes disease is a chronic disease with multiple causes, but in general it occurs when the level of glucose in the blood rises and leads to many symptoms and co-morbidities, some of which can be serious. It is also a very common disease whose incidence is increasing over time, with about 537 million adults around the world suffering from diabetes disease and this number is expected to increase to 643 million by 2030.
What is diabetes disease?
Diabetes disease is a health condition characterized by extremely high levels of blood sugar (glucose). Glucose is the body’s main source of energy and comes mainly from carbohydrates found in foods and beverages. The blood carries glucose to all of the body’s cells to be used as an energy source.
People with diabetes disease have difficulty converting glucose into energy. When glucose is in the bloodstream, it needs a “key” to reach the cells, and that key is the hormone insulin. Insulin is produced by the pancreas and helps transport glucose into the body’s cells. If the pancreas does not produce enough insulin or if the body does not use it effectively, glucose builds up in the bloodstream, leading to high blood sugar levels (hyperglycemia). It is important to note that there is another condition known as diabetes insipidus, which shares some symptoms such as increased thirst and frequent urination, but is completely different from diabetes disease.
Over time, high blood glucose levels can lead to serious health issues such as heart disease, nerve damage, and eye issues. Overall, diabetes disease requires constant attention and effective management to minimize the associated health risks and improve the quality of life for affected individuals.
Types of diabetes disease
There are many different types of diabetes disease, including:
Type 1 diabetes
Also known as insulin-dependent diabetes. It can occur at any age but is usually diagnosed in children and young adults. It is an autoimmune disease that occurs by an unknown mechanism that leads to the destruction of insulin-producing cells of the pancreas (insulin is a hormone that helps glucose reach the body’s cells and supply them with energy). As a result, insulin is not produced in sufficient quantity, and the body’s blood sugar level rises, and the body’s cells lack energy.
Type 2 diabetes
This is the most common type of diabetes, accounting for 90% to 95% of diabetes cases. Formerly known as non-insulin-dependent diabetes. It occurs at all ages but is more common in adults. It differs from type 1 diabetes in that not enough insulin is produced and/or the body’s cells do not respond to insulin normally (insulin resistance), resulting in high blood sugar levels and not enough of it reaching the body’s cells, and over time, it can cause serious damage to the body. Although it is common, you can take measures to help prevent it or at least delay its occurrence.
Pre-diabetes
This stage often precedes type 2 diabetes disease, where blood sugar levels are higher than normal, but not high enough to be diagnosed with type 2 diabetes disease. People with type 2 diabetes disease often develop prediabetes first, but it usually doesn’t cause symptoms. About 98 million people in the United States have prediabetes, but more than 80 percent of them don’t know they have it.
Gestational diabetes
Hyperglycemia is hyperglycemia in which blood glucose values are higher than normal but do not reach the level needed to diagnose diabetes. It occurs during pregnancy and usually goes away afterward, however, there is an increased risk of complications during pregnancy and childbirth in those who have it. These women, and possibly their children, are more likely to develop type 2 diabetes in the future.
Other less common but important types should be mentioned:
Type 3c diabetes
When the pancreas undergoes damage or injury (other than autoimmune damage), such as pancreatitis, pancreatic cancer, cystic fibrosis, and hemochromatosis, its ability to produce insulin is affected, and this type of diabetes occurs. Removal of the pancreas can also lead to type 3c.
Maturity Onset Diabetes in Young Adults (MODY)
It is a latent autoimmune type. It is also known as monogenic diabetes. It is caused by an inherited gene mutation that affects how the body produces and uses insulin. It affects up to 5% of people with diabetes, there are more than 10 different forms and is usually hereditary.
Neonatal diabetes
A type of monogenic diabetes disease. It occurs during the first six months of life. About 50% of affected children will have a permanent, lifelong form called neonatal diabetes. The other 50% will go away a few months after onset, called transient neonatal diabetes. But it can come back later.
Latent autoimmune diabetes in adults (LADA)
Type 1 diabetes is similar to type 2 diabetes in that an autoimmune reaction also causes it, but it develops much more slowly than type 1. People with it are usually over the age of 30.
Fragile Diabetes
It is a form of type 1 diabetes disease. It causes frequent, severe episodes of high and low blood sugar. These episodes often lead to hospitalization, and in rare cases, a pancreas transplant may be required to permanently treat the condition.
Causes of diabetes disease
The causes of diabetes disease vary, but it is generally caused by an elevated level of glucose in the blood, and include the following:
Insulin resistance
Type 2 diabetes, the most common type of diabetes, occurs when the pancreas does not produce enough insulin and/or the body has difficulty using it, known as insulin resistance. It occurs when muscle, fat, and liver cells do not respond well to insulin (when the body does not have enough insulin, the glucose in the blood cannot reach the cells, and as a result, the cells lack energy, the blood glucose level rises, and the person develops diabetes).
The cause of this resistance is not yet known, but several factors contribute to varying degrees of insulin resistance including: Overweight, physical inactivity, diet, hormonal imbalances, age 35 years or older (children and teenagers can be affected but the risk increases with age), family history of type 2 diabetes, smoking, including tobacco products and e-cigarettes or exposure to secondhand smoke, as well as certain medications.
Autoimmune diseases
Type 1 diabetes and LADA syndrome occur when the immune system attacks the insulin-producing beta cells in the pancreas, causing them to be completely absent and resulting in high blood glucose. Genes and certain environmental factors may trigger the immune system to destroy the beta cells in type 1 diabetes.
Hormonal imbalances
During pregnancy, the placenta releases hormones that cause insulin resistance, and if the pancreas cannot produce enough insulin to overcome this resistance, the pregnant woman will develop gestational diabetes. Other hormone-related conditions, such as acromegaly and Cushing’s syndrome, can cause type 2 diabetes.
Damage or removal of the pancreas: Occurs as a result of a medical condition, surgery, or trauma that affects its ability to produce insulin, thus leading to type 3c diabetes.
Gene mutations
Some of them can cause diabetes disease of early maturity in young adults (MODY) and neonatal diabetes.
Some medications
Long-term use of certain medications can also lead to type 2 diabetes disease, including HIV medications and corticosteroids.
Symptoms of diabetes disease
Common symptoms of diabetes disease include the following:
- Burnout
- Blurred vision
- Increased urination
- Slow healing of wounds and ulcers
- Unexplained weight loss
- Increased thirst (excessive thirst) and dry mouth
- Feeling very hungry even after eating
- Recurrent skin and/or vaginal yeast infections
There are some additional details regarding symptoms depending on each type of diabetes:
Type 1 Diabetes symptoms
Type 1 diabetes symptoms usually develop quickly, over the course of a few days or weeks. In addition to some of the common diabetes symptoms listed above, there may be additional symptoms that indicate a serious condition called diabetic ketoacidosis (DKA). It is caused by high levels of ketones resulting from using fat as an energy source instead of glucose and not producing enough insulin. DKA is life-threatening and requires immediate medical intervention. Its symptoms include: Difficulty breathing, stomach and abdominal pain, nausea, vomiting, bad breath (fruity odor), and fainting due to dehydration.
Type 2 Diabetes symptoms
The symptoms of type 2 diabetes disease usually develop slowly, over several years. The majority of patients do not experience any symptoms, or the symptoms may be so mild that they may not even notice them. In addition to the common symptoms of diabetes listed above, patients with type 2 diabetes may find out they have it when symptoms of other related health issues arise, including:
- loss of vision
- Pain, numbness, or tingling in the feet or hands
- Sexual problems
- Chest pain
Gestational diabetes symptoms
Most people with this type of diabetes disease have no symptoms, or they may be mild, such as feeling thirstier than usual or urinating more often. A gestational diabetes test is usually done between weeks 24 and 28 of pregnancy.
Diabetes diagnosis and testing
Healthcare providers diagnose diabetes by measuring the level of glucose in the blood, which can be measured by basic tests:
- Fasting blood sugar test: It is done to find out the basal blood sugar level, and you must abstain from food and drink except water for at least eight hours before the test.
- Random blood sugar test: This can be done at any time, regardless of whether you are fasting or not.
- The glycated hemoglobin (HbA1C) test: This is a blood test that shows the average blood glucose levels over the past three months. You can eat and drink before taking this test, but certain conditions should be taken into consideration, such as the second or third trimester of pregnancy, as well as certain types of anemia or other blood issues, as the A1C test may not be accurate. The A1C test result is given as a percentage, such as an A1C of 7%, where the higher the percentage, the higher the average blood sugar levels.
- Oral Glucose Tolerance Test (OGTT): Helps diagnose type 2 diabetes, prediabetes, and gestational diabetes. Prior to the test, you must fast for at least 8 hours. A blood sample is taken to measure the glucose level after fasting. The person then takes a sugar-rich liquid, and another sample is taken two hours later to check the blood sugar level. If the blood sugar level is high, diabetes is diagnosed. In pregnant women, a blood sample is drawn every hour for two to three hours. If blood sugar levels are elevated two or more times during the test, the pregnant woman may have gestational diabetes.
| Random plasma glucose test | Oral glucose tolerance test | Fasting plasma glucose | A1C | Diagnostics |
| Not available | 139 mg/dL or less | 99 mg/dL or less | Less than 5.7% | Normal |
| Not available | 140 to 199 mg/dL | 100 to 125 mg/dL | 5.7% to 6.4% | Pre-diabetes |
| 200 mg/dL or more | 200 mg/dL or more | 126 mg/dL or more | 6.5% or more | Diabetes |
Since treatment depends on the type of diabetes disease, doctors use more sensitive tests, such as genetic testing and autoantibody testing, to determine the type of diabetes.
Diabetes treatment
Diabetes disease is a complex condition, so its treatment requires multiple strategies depending on the type of diabetes. Monitoring blood sugar and taking insulin and oral medications are key to treatment. Diet and exercise are also important in managing diabetes.
Type 1 diabetes treatment
Treatment for type 1 diabetes includes insulin injections or the use of an insulin pump, regular blood sugar checks, and calorie control for some patients. Pancreas transplantation or islet cell transplantation may be an option when type 1 diabetes medications do not help. There are different ways to take insulin; a needle and syringe, an insulin pen, or an insulin pump may be used. An artificial pancreas (an automated insulin delivery system) may be another option for some people.
Type 2 diabetes treatment
Controlling your blood sugar level is key to treatment, through lifestyle changes. These include eating healthy meals and drinks, limiting calories if you are overweight or obese, and exercising. Many people with type 2 diabetes also need to take diabetes medications. These medications may include diabetes pills or injectable medications, such as insulin, so a doctor should be consulted to prescribe the best type 2 diabetes medications for each case.
Blood sugar monitoring
Accurate blood sugar testing is the only way to ensure that your blood sugar level stays within your target range. People receiving insulin therapy can also monitor their blood glucose levels with a continuous glucose monitor (CGM), a device that measures blood sugar every few minutes using a sensor implanted under the skin, which helps reduce the number of finger pricks needed to check blood sugar and provides important information about trends in blood sugar levels.
Insulin
Many types of insulin are available, including short-acting (regular), rapid-acting, long-acting, and intermediate-acting options. A combination of insulin types can be used for daytime and nighttime use. Insulin is not given orally because stomach enzymes interfere with its action. Insulin is often injected using a special needle and syringe or insulin pen; an insulin pump may also be an option.
An insulin pump is a small device that delivers steady doses of insulin throughout the day. One type is worn outside the body on a belt or in a pocket or bag. The insulin pump is connected to a small plastic tube and a very small needle. The plastic tube is inserted with a needle under the skin, and then the needle is removed. The plastic tube stays in place for several days while it’s connected to the insulin pump. The machine pumps insulin through the tube into the body around the clock and can be programmed to give more or less insulin as needed. Doses of insulin can also be administered through the pump during meals.
Another type of pump has no tubing. This pump is attached directly to the skin using a self-adhesive pad and is controlled by a handheld device. The plastic tube and pump device are replaced every few days.
Oral diabetes medications
Some can stimulate the pancreas to secrete more insulin, while others block the production and release of glucose from the liver, reducing the amount of insulin needed to transport sugar into the cells. There are also drugs that block stomach or intestinal enzymes that break down carbohydrates, slowing their absorption or making the body’s cells more sensitive to insulin. Metformin is one of the best and most commonly prescribed type 2 diabetes disease medications by doctors.
Another type of medication works at the level of the kidneys, preventing them from returning the filtered sugar back into the blood and helping to excrete it in the urine. These drugs are called SGLT2 inhibitors. Medications such as metformin, statins, and high blood pressure medications may be appropriate for some people with diabetes and other diseases such as heart disease.
If medications and lifestyle changes aren’t enough to manage your diabetes, there are other treatments that may help, including
- Weight-loss surgery (bariatric surgery) for some people with type 1 or type 2 diabetes.
- Pancreatic islet transplants are used for some people with type 1 diabetes.
Gestational diabetes treatment
Controlling your blood sugar level is essential to maintain a healthy fetus and avoid complications during delivery. In addition to a healthy diet and regular exercise, your gestational diabetes treatment plan may include blood sugar monitoring. In some cases, insulin or oral medications may also be used.
Pre-diabetes treatment
A healthy lifestyle can help normalize your blood sugar level and may prevent it from rising to a level high enough to be diagnosed with type 2 diabetes disease. Exercising, eating healthy, and losing about 7% of your body weight can help prevent or delay diabetes disease.
Stem cell diabetes treatment
Promising preliminary results after rigorous research have paved the way for a paradigm shift in treatment, giving patients hope for a full recovery from this incurable disease. VX-880, an experimental stem cell-derived, fully differentiated pancreatic islet cell replacement therapy for patients with type 1 diabetes, was developed in conjunction with immunosuppressive therapy. VX-880 effectively restored pancreatic islet cell function at day 90 in the first patient in its Phase I/II clinical trial.
How to prevent diabetes disease
Autoimmune and hereditary diabetes disease cannot be prevented, but there are some tips to minimize the risk of pre-diabetes, type 2 diabetes, and gestational diabetes:
- Manage stress and get enough rest and sleep (7 to 9 hours)
- Consult a doctor when you suspect symptoms, and don’t take them lightly
- Healthy diet and weight control
- Abstain from or minimize alcohol intake
- Exercise regularly
- Refrain from smoking
Complications of diabetes disease
The risk of diabetes complications gradually increases the longer you have diabetes and the less well-controlled your blood sugar level is:
- Diabetic neuropathy (diabetes-induced nerve damage, especially to the nerves of the foot, leading to nerve damage)
- Diabetic eye disease (such as diabetic retinopathy, which can lead to blindness)
- Skin conditions, including bacterial and fungal infections
- Alzheimer’s disease, especially in type 2 diabetes
- Cardiovascular disease
- Diabetes-related depression
- Diabetic nephropathy
- Hearing impairment
In conclusion, diabetes disease is a chronic condition that requires constant attention and effective management. By understanding the different types of diabetes disease and their causes, individuals can take steps to prevent or manage them. Lifestyle changes, such as a healthy diet and regular exercise, play a big role in improving the quality of life and minimizing the health risks associated with diabetes disease, and advances in treatments such as stem cell therapy offer new hope for patients. With proper management and prevention, diabetes disease can be managed and a healthy and productive life can be lived.
Sources:
- World Health Organization. (2021, December 14). Diabetes. World Health Organization.
- National Institute of Diabetes and Digestive and Kidney Diseases (n.d.). What is diabetes? National Institute of Health
