Diabetes is a disease where blood glucose levels are too high due to the body either not producing enough insulin or not properly using the insulin it does produce. There are three main types of diabetes: type 1 where the body does not produce insulin; type 2 where cells do not properly respond to insulin; and gestational diabetes which occurs during pregnancy. Type 1 diabetes is treated through insulin administration and managing diet and exercise, as high blood glucose can lead to serious short and long-term health complications if not properly managed.

1. DIABETES
Diabetes is a disease that occurs when your blood glucose, also called blood
sugar, is too high. Blood glucose is your main source of energy and comes
from the food you eat. Insulin, a hormone made by the pancreas, helps
glucose from food get into your cells to be used for energy. Sometimes your
body doesn’t make enough—or any—insulin or doesn’t use insulin well.
Glucose then stays in your blood and doesn’t reach your cells.
Over time, having too much glucose in your blood can cause health problems.
Although diabetes has no cure, you can take steps to manage your
diabetes and stay healthy.
Diabetes, is a group of metabolic disorders characterized by high blood
sugar levels over a prolonged period. Symptoms of high blood sugar
include frequent urination, increased thirst, and increased hunger. If left
untreated, diabetes can cause many complications.
Acute complications can include
 Diabetic ketoacidosis,
 Hyperosmolar hyperglycemic state, or death.
Serious long-term complications include
 Cardiovascular disease,
 Stroke,
 Chronic kidney disease,
 Foot ulcers,
 Damage to the eyes.
Sometimes people call diabetes “a touch of sugar” or “borderline
diabetes.” These terms suggest that someone doesn’t really have
diabetes or has a less serious case, but every case of diabetes is serious.

2. TYPES OF DIABETES:
Diabetes is characterized into 3 categories given below:
 TYPE-1 DIABETES: Results from the pancreas's failure to produce enough
insulin due to loss of beta cells ,this form was previously referred to as
"insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes".
 TYPE -2 DIABETES: Begins with insulin resistance, a condition in which
cells fail to respond to insulin properly. As the disease progresses, a lack
of insulin may also develop. This form was previously referred to as "non-
insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes.
The most common cause is a combination of excessive body
weight and insufficient exercise.
 GESTATIONAL DIABETES: Is the third main form, and occurs
when pregnant women without a previous history of diabetes develop
high blood sugar levels.

3. TYPE- 1 DIABETES:
Type 1 diabetes (T1D), also known as juvenile diabetes, is a form
of diabetes in which very little or no insulin is produced by the pancreas.
Before treatment this results in high blood sugar levels in the body. The
classic symptoms are frequent urination, increased thirst, increased hunger,
and weight loss. Additional symptoms may include blurry vision, feeling tired,
and poor wound healing. Symptoms typically develop over a short period of
time.
The cause of type 1 diabetes is unknown. However, it is believed to involve a
combination of genetic and environmental factors. Risk factors include having
a family member with the condition. The underlying mechanism involves
an autoimmune destruction of the insulin-producing beta cells in
the pancreas. Diabetes is diagnosed by testing the level of sugar or glycated
hemoglobin (HbA1C) in the blood. Type 1 diabetes can be distinguished
from type 2 by testing for the presence of auto antibodies.
There is no known way to prevent type 1 diabetes. Treatment with insulin is
required for survival. Insulin therapy is usually given by injection just under
the skin but can also be delivered by an insulin pump. A diabetic diet and
exercise are important parts of management. If left untreated, diabetes can
cause many complications. Complications of relatively rapid onset
include diabetic ketoacidosis and non-ketotic hyperosmolar coma. Long-term
complications include heart disease, stroke, kidney failure, foot ulcers
and damage to the eyes. Furthermore, complications may arise from low
blood sugar caused by excessive dosing of insulin.
Damage to beta cells from type 1 diabetes throws the process off. Glucose
doesn’t move into your cells because insulinisn’t there to do it. Instead it builds
up in your blood and your cells starve. This causes high blood sugar, which can
lead to:
 Dehydration. When there’s extra sugar in your blood, you pee more.
That’s your body’s way of getting rid of it. A large amount of water goes
out with that urine, causing your body to dry out.

4.  Weight loss. The glucose that goes out when you pee takes calories with
it. That’s why many people with high blood sugar lose
weight. Dehydration also plays a part.
 Diabetic ketoacidosis (DKA). If your body can't get enough glucose for
fuel, it breaks down fat cells instead. This creates chemicals called ketones.
Your liver releases the sugar it stores to help out. But your body can’t use
it without insulin,so it builds up in your blood, alongwith the acidic
ketones. This combinationof extra glucose, dehydration, and acid buildup
is known as "ketoacidosis" and can be life-threatening if not treated right
away.
 Damage to your body. Over time, high glucose levels in your blood can
harm the nerves and small blood vessels in your eyes, kidneys,and heart.
They can also make you more likely to get hardening of the arteries,
or atherosclerosis, which can lead to heart attacks and strokes.
Type 1 diabetes makes up an estimated 5–10% of all diabetes cases. The
number of people affected globally is unknown, although it is estimated that
about 80,000 children develop the disease each year. Within the United
States the number of people affected is estimated at one to three
million. Rates of disease vary widely with approximately 1 new case per
100,000 per year in East Asia and Latin America and around 30 new cases per
100,000 per year in Scandinavia and Kuwait

5. Diagnosis
Diagnostic tests include:
 Glycated hemoglobin (A1C) test. This blood test indicates your average
blood sugar level for the past two to three months. It measures the
percentage of blood sugar attached to the oxygen-carrying protein in red
blood cells (hemoglobin). The higher your blood sugar levels, the more
hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent
or higher on two separate tests indicates diabetes.
If the A1C test isn't available, or if you have certain conditions that can make
the A1C test inaccurate — such as pregnancy or an uncommon form of
hemoglobin (hemoglobin variant) — your doctor may use these tests:
 Random blood sugar test. A blood sample will be taken at a random time
and may be confirmed by repeat testing. Blood sugar values are
expressed in milligrams per deciliter (mg/dL) or millimoles per liter
(mmol/L). Regardless of when you last ate, a random blood sugar level of
200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when
coupled with any of the signs and symptoms of diabetes, such as frequent
urination and extreme thirst.
 Fasting blood sugar test. A blood sample will be taken after an overnight
fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is
normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9
mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher
on two separate tests, you have diabetes.
If you're diagnosed with diabetes, your doctor may also run blood tests to
check for autoantibodies that are common in type 1 diabetes. These tests
help your doctor distinguish between type 1 and type 2 diabetes when the
diagnosis is uncertain. The presence of ketones — byproducts from the
breakdown of fat — in your urine also suggests type 1 diabetes, rather than
type 2.

6. After the diagnosis
You'll regularly visit your doctor to discuss diabetes management. During
these visits, the doctor will check your A1C levels. Your target A1C goal may
vary depending on your age and various other factors, but the American
Diabetes Association generally recommends that A1C levels be below 7
percent, which translates to an estimated average glucose of 154 mg/dL (8.5
mmol/L).Compared with repeated daily blood sugar tests, A1C testing better
indicates how well your diabetes treatment plan is working. An elevated A1C
level may signal the need for a change in your insulin regimen, meal plan or
both.
In addition to the A1C test, the doctor will also take blood and urine samples
periodically to check your cholesterol levels, thyroid function, liver function
and kidney function. The doctor will also examine you to assess your blood
pressure and will check the sites where you test your blood sugar and deliver
insulin.
Treatment
Treatment for type 1 diabetes includes:
 Taking insulin
 Carbohydrate, fat and protein counting
 Frequent blood sugar monitoring
 Eating healthy foods
 Exercising regularly and maintaining a healthy weight
The goal is to keep your blood sugar level as close to normal as possible to
delay or prevent complications. Generally, the goal is to keep your daytime
blood sugar levels before meals between 80 and 130 mg/dL (4.44 to 7.2
mmol/L) and your after-meal numbers no higher than 180 mg/dL (10 mmol/L)
two hours after eating.

7. Insulin and other medications
Anyone who has type 1 diabetes needs lifelong insulin therapy.
Types of insulin are many and include:
 Short-acting (regular) insulin
 Rapid-acting insulin
 Intermediate-acting (NPH) insulin
 Long-acting insulin
Examples of short-acting (regular) insulin include Humulin R and Novolin R.
Rapid-acting insulin examples are insulin glulisine (Apidra), insulin lispro
(Humalog) and insulin aspart (Novolog). Long-acting insulins include insulin
glargine (Lantus, Toujeo Solostar), insulin detemir (Levemir) and insulin
degludec (Tresiba). Intermediate-acting insulins include insulin NPH (Novolin
N, Humulin N).

.
Other medications

8. Additional medications also may be prescribed for people with type 1 diabetes, such
as:
 High blood pressuremedications. Your doctor may prescribeangiotensin-
converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) to help
keep your kidneys healthy. These medications are recommended for people with
diabetes who have blood pressures above140/90 millimeters of mercury (mm Hg).
 Aspirin. Your doctor may recommend you take baby or regular aspirin daily to
protect your heart.
 Cholesterol-lowering drugs. Cholesterol guidelines tend to be more aggressive
for people with diabetes because of the elevated risk of heart disease. The American
Diabetes Association recommends that low-density lipoprotein (LDL, or "bad")
cholesterol be below 100 mg/dL (2.6 mmol/L). Your high-density lipoprotein (HDL,
or "good") cholesterolis recommended to be over 50 mg/dL (1.3 mmol/L) in women
and over 40 mg/dL (1 mmol/L) in men. Triglycerides, another type of blood fat, are
ideal when they're less than 150 mg/dL (1.7 mmol/L).
Blood sugar monitoring
Depending on whattype of insulin therapy you select or require, you may need to check
and record your blood sugar level at least four times a day.Even if you take insulin and
eat on a rigid schedule, blood sugar levels can change unpredictably. You'll learn how
your blood sugar level changes in responseto food, activity, illness, medications, stress,
hormonalchanges and alcohol.
Healthy eating and monitoring carbohydrates
Foods to eat for a type1 diabetic diet include complexcarbohydrates such as
 brown rice,
 whole wheat,
 quinoa,
 oatmeal,
 fruits,
 vegetables,
 beans, and
 lentils.

9. Foods to avoid for a type 1 diabetes diet include
 =Sodas (both diet and regular),
 Simple carbohydrates - processed/refined sugars (white bread, pastries, chips,
cookies, pastas).
 Trans fats (anything with the word hydrogenated on the label), and high-fat animal
products..
You'll need to learn how to count the amount of carbohydrates in the foods you eat so
that you can give yourself enough insulin to properly metabolize those carbohydrates. .
Signs of trouble
Despite your best efforts, sometimes problems will arise. Certain short-term
complications of type 1 diabetes, such as hypoglycemia, requireimmediate care.
Low blood sugar (hypoglycemia). This occurs when your blood sugar level drops
below your target range. Ask your doctor what's considered a low blood sugar level for
you. Blood sugar levels can drop for many reasons, including skipping a meal, eating
fewer carbohydrates than called for in your meal plan, getting more physicalactivity than
normal or injecting too much insulin.
Learn the symptoms of hypoglycemia, and test your blood sugar if you think your levels
are dropping. When in doubt, always test your blood sugar. Early signs and symptoms of
low blood sugar include:
 Sweating
 Shakiness
 Hunger
 Dizziness or lightheadedness
 Rapid or irregular heart rate
 Fatigue
 Headaches
 Blurred vision
 Irritability

10. Hypoglycemiaunawareness. Somepeople may lose the ability to sensethat their blood
sugar levels are getting low, called hypoglycemia unawareness. Thebody no longer
reacts to a low blood sugar level with symptoms such as lightheadedness or headaches.
The more you experience low blood sugar, the more likely you are to develop
hypoglycemia unawareness.
Highblood sugar (hyperglycemia). Your blood sugar can risefor many reasons, including
eating too much, eating the wrong types of foods, nottaking enough insulin or fighting
an illness.
Watch for:
 Frequent urination
 Increased thirst
 Blurred vision
 Fatigue
 Irritability
 Hunger
 Difficulty concentrating
If you suspecthyperglycemia, check your blood sugar. If your blood sugar is higher than
your target range, you'll likely need to administer a "correction" — an additional dose of
insulin that should bring your blood sugar back to normal. High blood sugar levels don't
come down as quickly as they go up.
If you have a blood sugar reading above240 mg/dL (13.3 mmol/L), test for ketones using
a urine test stick. Don'texercise if your blood sugar level is above240 mg/dL or if
ketones arepresent. If only a trace or small amounts of ketones are present, drink extra
fluids to flush out the ketones.If your blood sugar is persistently above300 mg/dL (16.7
mmol/L), or if your urine ketones remain high despite taking appropriatecorrection
doses of insulin, call your doctor or seek emergency care.
Increasedketones inyour urine (diabetic ketoacidosis). If yourcells are starved for
energy, your body may begin to break down fat — producing toxic acids known as
ketones. Diabetic ketoacidosis is a life-threatening emergency.

11. Signs and symptoms of this serious condition include:
 Nausea
 Vomiting
 Abdominal pain
 A sweet, fruity smell on your breath
 Weight loss
TYPE -2 DIABETES :
Type 2 diabetes is a chronic condition that affects the way your body metabolizes sugar
(glucose) — an important sourceof fuel for your body.
With type 2 diabetes, your body either resists the effects of insulin — a hormonethat
regulates the movement of sugar into your cells — or doesn't produceenough insulin to
maintain normal glucoselevels.
Type 2 diabetes used to be known as adult-onsetdiabetes, but today more children are
being diagnosed with the disorder, probably dueto the risein childhood obesity. There's
no cure for type 2 diabetes, but losing weight, eating well and exercising can help
manage the disease. If diet and exercise aren't enough to manage your blood sugar well,
you may also need diabetes medications or insulin therapy.
Symptoms:
Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can
have type 2 diabetes for years and not know it. Look for:
 Increased thirst
 Frequent urination
 Increased hunger
 Unintended weight loss
 Fatigue

12.  Blurred vision
 Slow-healing sores
 Frequent infections
 Areas of darkened skin, usually in the armpits and neck
Causes
Type 2 diabetes develops when the body becomes resistantto insulin or when the
pancreas is unable to produce enough insulin. Exactly why this happens is unknown,
although genetics and environmentalfactors, such as being overweightand inactive,
seem to be contributing factors.
How insulin works: Insulin is a hormonethat comes fromthe gland situated behind
and below the stomach (pancreas).
 The pancreas secretes insulin into the bloodstream.
 The insulin circulates, enabling sugar to enter your cells.
 Insulin lowers the amountof sugar in your bloodstream.
 As your blood sugar level drops, so does the secretion of insulin from your pancreas.
The role of glucose: Glucose— a sugar —is a main sourceof energy for the cells that
make up muscles and other tissues.
 Glucosecomes fromtwo major sources: food and your liver.
 Sugar is absorbed into the bloodstream, where it enters cells with the help of
insulin.
 Your liver stores and makes glucose.
 When your glucoselevels are low, such as when you haven't eaten in a while, the
liver breaks down stored glycogen into glucoseto keep your glucoselevel within a
normal range.
In type 2 diabetes, this process doesn'twork well. Instead of moving into your cells,
sugar builds up in your bloodstream. As blood sugar levels increase, the insulin-
producing beta cells in the pancreas releasemore insulin, but eventually these cells
become impaired and can't make enough insulin to meet the body's demands.

13. In the much less common type 1 diabetes, the immune systemmistakenly destroys the
beta cells, leaving the body with little to no insulin.
Risk factors
Factors that may increase your risk of type 2 diabetes include:
 Weight. Being overweight is a main risk factor for type 2 diabetes. However, you don't
have to be overweight to develop type 2 diabetes.
 Fat distribution. If you store fat mainly in the abdomen, you have a greater risk of type 2
diabetes than if you store fat elsewhere, such as in your hips and thighs. Your risk of type
2 diabetes rises if you're a man with a waist circumference above 40 inches (101.6
centimeters) or a woman with a waist that's greater than 35 inches (88.9 centimeters).
 Inactivity. The less active you are, the greater your risk of type 2 diabetes. Physical
activity helps you control your weight, uses up glucose as energy and makes your cells
more sensitive to insulin.
 Family history. The risk of type 2 diabetes increases if your parent or sibling has type 2
diabetes.
 Race. Although it's unclear why, people of certain races — including black, Hispanic,
American Indian and Asian-American people — are more likely to develop type 2 diabetes
than white people are.
 Age. The risk of type 2 diabetes increases as you get older, especially after age 45. That's
probably because people tend to exercise less, lose muscle mass and gain weight as they
age. But type 2 diabetes is also increasing dramatically among children, adolescents and
younger adults.
 Prediabetes. Prediabetes is a condition in which your blood sugar level is higher than
normal, but not high enough to be classified as diabetes. Left untreated, prediabetes often
progresses to type 2 diabetes.
 Gestational diabetes. If you developed gestational diabetes when you were pregnant,
your risk of developing type 2 diabetes increases. If you gave birth to a baby weighing
more than 9 pounds (4 kilograms), you're also at risk of type 2 diabetes.
 Polycystic ovarian syndrome. For women, having polycystic ovarian syndrome — a
common condition characterized by irregular menstrual periods, excess hair growth and
obesity — increases the risk of diabetes.
 Areas of darkened skin, usually in the armpits and neck. This condition often indicates
insulin resistance.

14. Complications
Type 2 diabetes can be easy to ignore, especially in the early stages when you're feeling
fine. But diabetes affects many major organs, including your heart, blood vessels, nerves,
eyes and kidneys. Controlling your blood sugar levels can help prevent these
complications. Although long-term complications of diabetes develop gradually, they can
eventually be disabling or even life-threatening. Some of the potential complications of
diabetes include:
 Heart and blood vessel disease. Diabetes dramatically increases the risk of heart
disease, stroke, high blood pressureand narrowing of blood vessels
(atherosclerosis).
 Nerve damage (neuropathy). Excess sugar can cause tingling, numbness, burning or
pain that usually begins at the tips of the toes or fingers and gradually spreads
upward. Eventually, you may lose all sense of feeling in the affected limbs.
Damage to the nerves that control digestion can cause problems with nausea,
vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue.
 Kidney damage. Diabetes can sometimes lead to kidney failure or irreversibleend-
stage kidney disease, which may require dialysis or a kidney transplant.
 Eye damage. Diabetes increases the risk of serious eyediseases, such as cataracts
and glaucoma, and may damage the blood vessels of the retina, potentially leading
to blindness.
 Slow healing. Left untreated, cuts and blisters can become serious infections, which
may heal poorly. Severedamage might requiretoe, foot or leg amputation.
 Hearing impairment. Hearing problems are more common in people with diabetes.
 Skin conditions. Diabetes may leave you more susceptible to skin problems,
including bacterial and fungal infections.
 Sleepapnea. Obstructivesleep apnea is common in people with type 2 diabetes.
Obesity may be the main contributing factor to both conditions. Treating sleep
apnea may lower your blood pressureand makeyou feel morerested, but it's not
clear whether it helps improve blood sugar control.
 Alzheimer's disease. Type2 diabetes seems to increasethe risk of Alzheimer's
disease, though it's not clear why. The worseyour blood sugar control, the greater
the risk appears to be.

15. Prevention
Healthy lifestyle choices can help prevent type 2 diabetes, and that's true even if you
have diabetes in your family. If you'vealready received a diagnosis of diabetes, you can
use healthy lifestyle choices to help prevent complications. If you have prediabetes,
lifestyle changes can slow or stop the progression to diabetes.
A healthy lifestyle includes:
 Eating healthy foods. Choosefoods lower in fat and calories and higher in fiber.
Focus on fruits, vegetables and whole grains.
 Getting active. Aimfor a minimum of 30 to 60 minutes of moderate physical activity
— or 15 to 30 minutes of vigorous aerobic activity — on mostdays. Take a brisk
daily walk. Ride a bike. Swimlaps. If you can't fit in a long workout, spread your
activity throughoutthe day.
 Losing weight. If you'reoverweight, losing 5 to 10 percent of your body weight can
reduce the risk of diabetes. To keep your weight in a healthy range, focus on
permanent changes to your eating and exercise habits. Motivate yourself by
remembering the benefits of losing weight, such as a healthier heart, more energy
and improved self-esteem.
 Avoiding being sedentary for long periods. Sitting still for long periods can increase
your risk of type 2 diabetes. Try to get up every 30 minutes and move around for at
least a few minutes.
Sometimes medication is an option as well. Metformin (Glucophage, Glumetza, others),
an oral diabetes medication, may reduce the risk of type 2 diabetes. But even if you take
medication, healthy lifestyle choices remain essential for preventing or managing
diabetes.