Diabetes mellitus type 1 and type 2 by mohammad yaser hussain

DIABETES MELLITUS TYPE 1
AND TYPE 2
Diabetes mellitus (DM), commonly referred to as diabetes, is a
group of metabolic diseases in which there are high blood sugar
levels over a prolonged period.[2]
Symptoms of high blood sugar
include frequent urination, increased thirst, and increased hunger. If
left untreated, diabetes can cause many complications.[3]
Acute complications include diabetic
ketoacidosis and nonketotic hyperosmolar coma.[4]
Serious long-term complications include
cardiovascular disease, stroke, chronic kidney failure, foot ulcers, and damage to the eyes.[3]
Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not
responding properly to the insulin produced.[5]
There are three main types of diabetes mellitus:
 Type 1 DM results from the pancreas's failure to produce enough insulin. This form was
previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile
diabetes". The cause is unknown.[3]
 Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to
insulin properly.[3]
As the disease progresses a lack of insulin may also develop.[6]
This
form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM)
or "adult-onset diabetes". The primary cause is excessive body weight and not enough
exercise.[3]
 Gestational diabetes, is the third main form and occurs when pregnant women without a
previous history of diabetes develop high blood-sugar levels.[3]
Prevention and treatment involve a healthy diet, physical exercise, maintaining a normal body
weight, and avoiding use of tobacco. Control of blood pressure and maintaining proper foot care
are important for people with the disease. Type 1 DM must be managed with insulin injections.[3]
Type 2 DM may be treated with medications with or without insulin.[7]
Insulin and some oral
medications can cause low blood sugar.[8]
Weight loss surgery in those with obesity is sometimes
an effective measure in those with type 2 DM.[9]
Gestational diabetes usually resolves after the
birth of the baby.[10]
As of 2015, an estimated 415 million people have diabetes worldwide,[11]
with type 2 DM making
up about 90% of the cases.[12][13]
This represents 8.3% of the adult population,[13]
with equal rates
in both women and men.[14]
From 2012 to 2015, diabetes is estimated to have resulted in 1.5 to
5.0 million deaths each year.[7][11]
Diabetes at least doubles a person's risk of death.[3]
The number
of people with diabetes is expected to rise to 592 million by 2035.
Signs and symptoms
2016
Apollo
hospitals
MOHAMMAD
YASER
HUSSAIN

Overview of the most significant symptoms of diabetes
The classic symptoms of untreated diabetes are weight loss, polyuria (increased urination),
polydipsia (increased thirst), and polyphagia (increased hunger).[18]
Symptoms may develop
rapidly (weeks or months) in type 1 DM, while they usually develop much more slowly and may
be subtle or absent in type 2 DM.
Several other signs and symptoms can mark the onset of diabetes, although they are not specific
to the disease. In addition to the known ones above, they include blurry vision, headache, fatigue,
slow healing of cuts, and itchy skin. Prolonged high blood glucose can cause glucose absorption
in the lens of the eye, which leads to changes in its shape, resulting in vision changes. A number
of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes.
Diabetic emergencies
Low blood sugar is common in persons with type 1 and type 2 DM. Most cases are mild and are
not considered medical emergencies. Effects can range from feelings of unease, sweating,
trembling, and increased appetite in mild cases to more serious issues such as confusion, changes
in behavior, seizures, unconsciousness, and (rarely) permanent brain damage or death in severe
cases.[19][20]
Mild cases are self-treated by eating or drinking something high in sugar. Severe cases
can lead to unconsciousness and must be treated with intravenous glucose or injections with
glucagon.
People (usually with type 1 DM) may also experience episodes of diabetic ketoacidosis, a
metabolic disturbance characterized by nausea, vomiting and abdominal pain, the smell of
acetone on the breath, deep breathing known as Kussmaul breathing, and in severe cases a
decreased level of consciousness.[21]

A rare but equally severe possibility is hyperosmolar nonketotic state, which is more common in
type 2 DM and is mainly the result of dehydration.[21]
Complications
Main article: Complications of diabetes mellitus
All forms of diabetes increase the risk of long-term complications. These typically develop after
many years (10–20), but may be the first symptom in those who have otherwise not received a
diagnosis before that time.
The major long-term complications relate to damage to blood vessels. Diabetes doubles the risk
of cardiovascular disease[22]
and about 75% of deaths in diabetics are due to coronary artery
disease.[23]
Other "macrovascular" diseases are stroke, and peripheral vascular disease.
The primary complications of diabetes due to damage in small blood vessels include damage to
the eyes, kidneys, and nerves.[24]
Damage to the eyes, known as diabetic retinopathy, is caused by
damage to the blood vessels in the retina of the eye, and can result in gradual vision loss and
blindness.[24]
Damage to the kidneys, known as diabetic nephropathy, can lead to tissue scarring,
urine protein loss, and eventually chronic kidney disease, sometimes requiring dialysis or kidney
transplant.[24]
Damage to the nerves of the body, known as diabetic neuropathy, is the most
common complication of diabetes.[24]
The symptoms can include numbness, tingling, pain, and
altered pain sensation, which can lead to damage to the skin. Diabetes-related foot problems
(such as diabetic foot ulcers) may occur, and can be difficult to treat, occasionally requiring
amputation. Additionally, proximal diabetic neuropathy causes painful muscle wasting and
weakness.
There is a link between cognitive deficit and diabetes. Compared to those without diabetes, those
with the disease have a 1.2 to 1.5-fold greater rate of decline in cognitive function.[25]
Causes
Comparison of type 1 and 2 diabetes[12]
Feature Type 1 diabetes Type 2 diabetes
Onset Sudden Gradual
Age at onset Mostly in children Mostly in adults
Body size Thin or normal[26]
Often obese

Ketoacidosis Common Rare
Autoantibodies Usually present Absent
Endogenous insulin Low or absent
Normal, decreased
or increased
Concordance
in identical twins
50% 90%
Prevalence ~10% ~90%
Diabetes mellitus is classified into four broad categories: type 1, type 2, gestational diabetes, and
"other specific types".[5]
The "other specific types" are a collection of a few dozen individual
causes.[5]
The term "diabetes", without qualification, usually refers to diabetes mellitus.
Type 1
Main article: Diabetes mellitus type 1
Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets
of Langerhans in the pancreas, leading to insulin deficiency. This type can be further classified
as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated
nature, in which a T-cell-mediated autoimmune attack leads to the loss of beta cells and thus
insulin.[27]
It causes approximately 10% of diabetes mellitus cases in North America and Europe.
Most affected people are otherwise healthy and of a healthy weight when onset occurs.
Sensitivity and responsiveness to insulin are usually normal, especially in the early stages.
Type 1 diabetes can affect children or adults, but was traditionally termed "juvenile diabetes"
because a majority of these diabetes cases were in children.
"Brittle" diabetes, also known as unstable diabetes or labile diabetes, is a term that was
traditionally used to describe the dramatic and recurrent swings in glucose levels, often occurring
for no apparent reason in insulin-dependent diabetes. This term, however, has no biologic basis
and should not be used.[28]
Still, type 1 diabetes can be accompanied by irregular and
unpredictable high blood sugar levels, frequently with ketosis, and sometimes with serious low
blood sugar levels. Other complications include an impaired counterregulatory response to low
blood sugar, infection, gastroparesis (which leads to erratic absorption of dietary carbohydrates),
and endocrinopathies (e.g., Addison's disease).[28]
These phenomena are believed to occur no
more frequently than in 1% to 2% of persons with type 1 diabetes.[29]
Type 1 diabetes is partly inherited, with multiple genes, including certain HLA genotypes,
known to influence the risk of diabetes. In genetically susceptible people, the onset of diabetes
can be triggered by one or more environmental factors, such as a viral infection or diet. There is

some evidence that suggests an association between type 1 DM and Coxsackie B4 virus. Unlike
type 2 DM, the onset of type 1 diabetes is unrelated to lifestyle.
Type 2
Main article: Diabetes mellitus type 2
Type 2 DM is characterized by insulin resistance, which may be combined with relatively
reduced insulin secretion.[5]
The defective responsiveness of body tissues to insulin is believed to
involve the insulin receptor. However, the specific defects are not known. Diabetes mellitus
cases due to a known defect are classified separately. Type 2 DM is the most common type of
diabetes mellitus.
In the early stage of type 2, the predominant abnormality is reduced insulin sensitivity. At this
stage, high blood sugar can be reversed by a variety of measures and medications that improve
insulin sensitivity or reduce the liver's glucose production.
Type 2 DM is due primarily to lifestyle factors and genetics.[30]
A number of lifestyle factors are
known to be important to the development of type 2 DM, including obesity (defined by a body
mass index of greater than 30), lack of physical activity, poor diet, stress, and urbanization.[12]
Excess body fat is associated with 30% of cases in those of Chinese and Japanese descent, 60–
80% of cases in those of European and African descent, and 100% of Pima Indians and Pacific
Islanders.[5]
Even those who are not obese often have a high waist–hip ratio.[5]
Dietary factors also influence the risk of developing type 2 DM. Consumption of sugar-
sweetened drinks in excess is associated with an increased risk.[31][32]
The type of fats in the diet is
also important, with saturated fats and trans fatty acids increasing the risk and polyunsaturated
and monounsaturated fat decreasing the risk.[30]
Eating lots of white rice also may increase the
risk of diabetes.[33]
A lack of exercise is believed to cause 7% of cases.[34]
Gestational diabetes
Main article: Gestational diabetes
Gestational diabetes mellitus (GDM) resembles type 2 DM in several respects, involving a
combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2–
10% of all pregnancies and may improve or disappear after delivery.[35]
However, after pregnancy
approximately 5–10% of women with gestational diabetes are found to have diabetes mellitus,
most commonly type 2.[35]
Gestational diabetes is fully treatable, but requires careful medical
supervision throughout the pregnancy. Management may include dietary changes, blood glucose
monitoring, and in some cases insulin may be required.
Though it may be transient, untreated gestational diabetes can damage the health of the fetus or
mother. Risks to the baby include macrosomia (high birth weight), congenital heart and central
nervous system abnormalities, and skeletal muscle malformations. Increased levels of insulin in a
fetus's blood may inhibit fetal surfactant production and cause respiratory distress syndrome. A

high blood bilirubin level may result from red blood cell destruction. In severe cases, perinatal
death may occur, most commonly as a result of poor placental perfusion due to vascular
impairment. Labor induction may be indicated with decreased placental function. A Caesarean
section may be performed if there is marked fetal distress or an increased risk of injury
associated with macrosomia, such as shoulder dystocia.[citation needed]
Other types
Prediabetes indicates a condition that occurs when a person's blood glucose levels are higher
than normal but not high enough for a diagnosis of type 2 DM. Many people destined to develop
type 2 DM spend many years in a state of prediabetes.
Latent autoimmune diabetes of adults (LADA) is a condition in which type 1 DM develops in
adults. Adults with LADA are frequently initially misdiagnosed as having type 2 DM, based on
age rather than etiology.
Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even
when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very
uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell
function. Abnormal insulin action may also have been genetically determined in some cases.
Any disease that causes extensive damage to the pancreas may lead to diabetes (for example,
chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-
antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess
is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells.
The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or
MMDM, ICD-10 code E12), was deprecated by the World Health Organization when the current
taxonomy was introduced in 1999.[36]
Other forms of diabetes mellitus include congenital diabetes, which is due to genetic defects of
insulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of
glucocorticoids, and several forms of monogenic diabetes.
"Type 3 diabetes" has been suggested as a term for Alzheimer's disease as the underlying
processes may involve insulin resistance by the brain.[37]
The following is a comprehensive list of other causes of diabetes:[38]
 Genetic defects of β-cell function
o Maturity onset diabetes of the
young
o Mitochondrial DNA mutations
 Genetic defects in insulin processing or
insulin action
o Defects in proinsulin conversion
o Insulin gene mutations
o Insulin receptor mutations
 Endocrinopathies
o Growth hormone excess
(acromegaly)
o Cushing syndrome
o Hyperthyroidism
o Pheochromocytoma
o Glucagonoma
 Infections
o Cytomegalovirus infection

 Exocrine pancreatic defects
o Chronic pancreatitis
o Pancreatectomy
o Pancreatic neoplasia
o Cystic fibrosis
o Hemochromatosis
o Fibrocalculous pancreatopathy
o Coxsackievirus B
 Drugs
o Glucocorticoids
o Thyroid hormone
o β-adrenergic agonists
o Statins[39]
Pathophysiology
The fluctuation of blood sugar (red) and the sugar-lowering hormone insulin (blue) in humans
during the course of a day with three meals — one of the effects of a sugar-rich vs a starch-rich
meal is highlighted.
Mechanism of insulin release in normal pancreatic beta cells — insulin production is more or
less constant within the beta cells. Its release is triggered by food, chiefly food containing
absorbable glucose.
Insulin is the principal hormone that regulates the uptake of glucose from the blood into most
cells of the body, especially liver, muscle, and adipose tissue. Therefore, deficiency of insulin or
the insensitivity of its receptors plays a central role in all forms of diabetes mellitus.[40]

The body obtains glucose from three main places: the intestinal absorption of food, the
breakdown of glycogen, the storage form of glucose found in the liver, and gluconeogenesis, the
generation of glucose from non-carbohydrate substrates in the body.[41]
Insulin plays a critical
role in balancing glucose levels in the body. Insulin can inhibit the breakdown of glycogen or the
process of gluconeogenesis, it can stimulate the transport of glucose into fat and muscle cells,
and it can stimulate the storage of glucose in the form of glycogen.[41]
Insulin is released into the blood by beta cells (β-cells), found in the islets of Langerhans in the
pancreas, in response to rising levels of blood glucose, typically after eating. Insulin is used by
about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, for
conversion to other needed molecules, or for storage. Lower glucose levels result in decreased
insulin release from the beta cells and in the breakdown of glycogen to glucose. This process is
mainly controlled by the hormone glucagon, which acts in the opposite manner to insulin.[42]
If the amount of insulin available is insufficient, if cells respond poorly to the effects of insulin
(insulin insensitivity or insulin resistance), or if the insulin itself is defective, then glucose will
not be absorbed properly by the body cells that require it, and it will not be stored appropriately
in the liver and muscles. The net effect is persistently high levels of blood glucose, poor protein
synthesis, and other metabolic derangements, such as acidosis.[41]
When the glucose concentration in the blood remains high over time, the kidneys will reach a
threshold of reabsorption, and glucose will be excreted in the urine (glycosuria).[43]
This increases
the osmotic pressure of the urine and inhibits reabsorption of water by the kidney, resulting in
increased urine production (polyuria) and increased fluid loss. Lost blood volume will be
replaced osmotically from water held in body cells and other body compartments, causing
dehydration and increased thirst (polydipsia).[41]
Diagnosis
See also: Glycated hemoglobin and Glucose tolerance test
WHO diabetes diagnostic criteria[44][45]
edit
Condition
2 hour
glucose
Fasting glucose HbA1c
Unit mmol/l(mg/dl) mmol/l(mg/dl) mmol/mol DCCT %
Normal <7.8 (<140) <6.1 (<110) <42 <6.0
Impaired fasting glycaemia <7.8 (<140)
≥6.1(≥110) &
<7.0(<126)
42-46 6.0–6.4
Impaired glucose tolerance ≥7.8 (≥140) <7.0 (<126) 42-46 6.0–6.4
Diabetes mellitus ≥11.1 (≥200) ≥7.0 (≥126) ≥48 ≥6.5
Diabetes mellitus is characterized by recurrent or persistent high blood sugar, and is diagnosed
by demonstrating any one of the following:[36]
 Fasting plasma glucose level ≥ 7.0 mmol/l (126 mg/dl)

 Plasma glucose ≥ 11.1 mmol/l (200 mg/dl) two hours after a 75 g oral glucose load as in
a glucose tolerance test
 Symptoms of high blood sugar and casual plasma glucose ≥ 11.1 mmol/l (200 mg/dl)
 Glycated hemoglobin (HbA1C) ≥ 48 mmol/mol (≥ 6.5 DCCT %).[46]
A positive result, in the absence of unequivocal high blood sugar, should be confirmed by a
repeat of any of the above methods on a different day. It is preferable to measure a fasting
glucose level because of the ease of measurement and the considerable time commitment of
formal glucose tolerance testing, which takes two hours to complete and offers no prognostic
advantage over the fasting test.[47]
According to the current definition, two fasting glucose
measurements above 126 mg/dl (7.0 mmol/l) is considered diagnostic for diabetes mellitus.
Per the World Health Organization people with fasting glucose levels from 6.1 to 6.9 mmol/l
(110 to 125 mg/dl) are considered to have impaired fasting glucose.[48]
people with plasma
glucose at or above 7.8 mmol/l (140 mg/dl), but not over 11.1 mmol/l (200 mg/dl), two hours
after a 75 g oral glucose load are considered to have impaired glucose tolerance. Of these two
prediabetic states, the latter in particular is a major risk factor for progression to full-blown
diabetes mellitus, as well as cardiovascular disease.[49]
The American Diabetes Association since
2003 uses a slightly different range for impaired fasting glucose of 5.6 to 6.9 mmol/l (100 to
125 mg/dl).[50]
Glycated hemoglobin is better than fasting glucose for determining risks of cardiovascular
disease and death from any cause.[51]
The rare disease diabetes insipidus has similar symptoms to diabetes mellitus, but without
disturbances in the sugar metabolism (insipidus means "without taste" in Latin) and does not
involve the same disease mechanisms. Diabetes is a part of the wider condition known as
metabolic syndrome.
Prevention
See also: Prevention of diabetes mellitus type 2
There is no known preventive measure for type 1 diabetes.[3]
Type 2 diabetes can often be
prevented by a person being a normal body weight, physical exercise, and following a healthful
diet.[3]
Dietary changes known to be effective in helping to prevent diabetes include a diet rich in
whole grains and fiber, and choosing good fats, such as polyunsaturated fats found in nuts,
vegetable oils, and fish.[52]
Limiting sugary beverages and eating less red meat and other sources
of saturated fat can also help in the prevention of diabetes.[52]
Active smoking is also associated
with an increased risk of diabetes, so smoking cessation can be an important preventive measure
as well.[53]
Management
Main article: Diabetes management

Diabetes mellitus is a chronic disease, for which there is no known cure except in very specific
situations.[54]
Management concentrates on keeping blood sugar levels as close to normal, without
causing low blood sugar. This can usually be accomplished with a healthy diet, exercise, weight
loss, and use of appropriate medications (insulin in the case of type 1 diabetes; oral medications,
as well as possibly insulin, in type 2 diabetes).
Learning about the disease and actively participating in the treatment is important, since
complications are far less common and less severe in people who have well-managed blood
sugar levels.[55][56]
The goal of treatment is an HbA1C level of 6.5%, but should not be lower than
that, and may be set higher.[57]
Attention is also paid to other health problems that may accelerate
the negative effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high
blood pressure, and lack of regular exercise.[57]
Specialized footwear is widely used to reduce the
risk of ulceration, or re-ulceration, in at-risk diabetic feet. Evidence for the efficacy of this
remains equivocal, however.[58]
Lifestyle
See also: Diabetic diet
People with diabetes can benefit from education about the disease and treatment, good nutrition
to achieve a normal body weight, and exercise, with the goal of keeping both short-term and
long-term blood glucose levels within acceptable bounds. In addition, given the associated higher
risks of cardiovascular disease, lifestyle modifications are recommended to control blood
pressure.[59]
Medications
See also: Anti-diabetic medication
Medications used to treat diabetes do so by lowering blood sugar levels. There are a number of
different classes of anti-diabetic medications. Some are available by mouth, such as metformin,
while others are only available by injection such as GLP-1 agonists. Type 1 diabetes can only be
treated with insulin, typically with a combination of regular and NPH insulin, or synthetic insulin
analogs.[citation needed]
Metformin is generally recommended as a first line treatment for type 2 diabetes, as there is good
evidence that it decreases mortality.[60]
It works by decreasing the liver's production of glucose.[61]
Several other groups of drugs, mostly given by mouth, may also decrease blood sugar in type II
DM. These include agents that increase insulin release, agents that decrease absorption of sugar
from the intestines, and agents that make the body more sensitive to insulin.[61]
When insulin is
used in type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral
medications.[60]
Doses of insulin are then increased to effect.[60][62]
Since cardiovascular disease is a serious complication associated with diabetes, some have
recommended blood pressure levels below 130/80 mmHg.[63]
However, evidence supports less
than or equal to somewhere between 140/90 mmHg to 160/100 mmHg; the only additional

benefit found for blood pressure targets beneath this range was an isolated decrease in stroke
risk, and this was accompanied by an increased risk of other serious adverse events.[64][65]
A 2016
review found potential harm to treating lower than 140 mmHg.[66]
Among medications that lower
blood pressure, angiotensin converting enzyme inhibitors (ACEIs) improve outcomes in those
with DM while the similar medications angiotensin receptor blockers (ARBs) do not.[67]
Aspirin
is also recommended for patient with cardiovascular problems, however routine use of aspirin
has not been found to improve outcomes in uncomplicated diabetes.[68]
Surgery
A pancreas transplant is occasionally considered for people with type 1 diabetes who have severe
complications of their disease, including end stage kidney disease requiring kidney
transplantation.[69]
Weight loss surgery in those with obesity and type two diabetes is often an effective measure.[70]
Many are able to maintain normal blood sugar levels with little or no medications following
surgery[71]
and long-term mortality is decreased.[72]
There however is some short-term mortality
risk of less than 1% from the surgery.[73]
The body mass index cutoffs for when surgery is
appropriate are not yet clear.[72]
It is recommended that this option be considered in those who are
unable to get both their weight and blood sugar under control.[74]
Support
In countries using a general practitioner system, such as the United Kingdom, care may take
place mainly outside hospitals, with hospital-based specialist care used only in case of
complications, difficult blood sugar control, or research projects. In other circumstances, general
practitioners and specialists share care in a team approach. Home telehealth support can be an
effective management technique.[75]
Epidemiology
Main article: Epidemiology of diabetes mellitus
Rates of diabetes worldwide in 2000 (per 1,000 inhabitants) — world average was 2.8%.
no data
≤ 7.5
7.5–15
45–52.5
52.5–60
60–67.5

15–22.5
22.5–30
30–37.5
37.5–45
67.5–75
75–82.5
≥ 82.5
Disability-adjusted life year for diabetes mellitus per 100,000 inhabitants in 2004
No data
<100
100–200
200–300
300–400
400–500
500–600
600–700
700–800
800–900
900–1,000
1,000–1,500
>1,500
As of 2013, 382 million people have diabetes worldwide.[13]
Type 2 makes up about 90% of the
cases.[12][14]
This is equal to 8.3% of the adult population[13]
with equal rates in both women and
men.[14]
In 2014, the International Diabetes Federation (IDF) estimated that diabetes resulted in 4.9
million deaths.[15]
The World Health Organization (WHO) estimated that diabetes resulted in 1.5
million deaths in 2012, making it the 8th leading cause of death.[7]
The discrepancy between the
two estimates is due to the fact that cardiovascular diseases are often the cause of death for
individuals with diabetes; the IDF uses modelling to estimate the amount of deaths that could be
attributed to diabetes.[16]
More than 80% of diabetic deaths occur in low and middle-income
countries.[76]
Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in more
developed countries. The greatest increase in rates was expected to occur in Asia and Africa,
where most people with diabetes will probably live in 2030.[77]
The increase in rates in
developing countries follows the trend of urbanization and lifestyle changes, including a
"Western-style" diet. This has suggested an environmental (i.e., dietary) effect, but there is little
understanding of the mechanism(s) at present.[77]
History
Main article: History of diabetes

Diabetes was one of the first diseases described,[78]
with an Egyptian manuscript from c. 1500
BCE mentioning "too great emptying of the urine".[79]
The first described cases are believed to be
of type 1 diabetes.[79]
Indian physicians around the same time identified the disease and classified
it as madhumeha or "honey urine", noting the urine would attract ants.[79]
The term "diabetes" or
"to pass through" was first used in 230 BCE by the Greek Apollonius of Memphis.[79]
The disease
was considered rare during the time of the Roman empire, with Galen commenting he had only
seen two cases during his career.[79]
This is possibly due to the diet and life-style of the ancient
people, or because the clinical symptoms were observed during the advanced stage of the
disease. Galen named the disease "diarrhea of the urine" (diarrhea urinosa). The earliest
surviving work with a detailed reference to diabetes is that of Aretaeus of Cappadocia (2nd or
early 3rd century CE). He described the symptoms and the course of the disease, which he
attributed to the moisture and coldness, reflecting the beliefs of the "Pneumatic School". He
hypothesized a correlation of diabetes with other diseases and he discussed differential diagnosis
from the snakebite which also provokes excessive thirst. His work remained unknown in the
West until the middle of the 16th century when, in 1552, the first Latin edition was published in
Venice.[80]
Type 1 and type 2 diabetes were identified as separate conditions for the first time by the Indian
physicians Sushruta and Charaka in 400-500 CE with type 1 associated with youth and type 2
with being overweight.[79]
The term "mellitus" or "from honey" was added by the Briton John
Rolle in the late 1700s to separate the condition from diabetes insipidus, which is also associated
with frequent urination.[79]
Effective treatment was not developed until the early part of the 20th
century, when Canadians Frederick Banting and Charles Herbert Best isolated and purified
insulin in 1921 and 1922.[79]
This was followed by the development of the long-acting insulin
NPH in the 1940s.[79]
Etymology
The word diabetes (/ˌdaɪ.əˈbiːtiːz/ or /ˌdaɪ.əˈbiːtᵻs/) comes from Latin diabētēs, which in turn
comes from Ancient Greek διαβήτης (diabētēs) which literally means "a passer through; a
siphon."[81]
Ancient Greek physician Aretaeus of Cappadocia (fl. 1st century CE) used that word,
with the intended meaning "excessive discharge of urine", as the name for the disease.[82][83][84]
Ultimately, the word comes from Greek διαβαίνειν (diabainein), meaning "to pass through,"[81]
which is composed of δια- (dia-), meaning "through" and βαίνειν (bainein), meaning "to go".[82]
The word "diabetes" is first recorded in English, in the form diabete, in a medical text written
around 1425.
The word mellitus (/mᵻˈlaɪtəs/ or /ˈmɛlᵻtəs/) comes from the classical Latin word mellītus,
meaning "mellite"[85]
(i.e. sweetened with honey;[85]
honey-sweet[86]
). The Latin word comes from
mell-, which comes from mel, meaning "honey";[85][86]
sweetness;[86]
pleasant thing,[86]
and the
suffix -ītus,[85]
whose meaning is the same as that of the English suffix "-ite".[87]
It was Thomas
Willis who in 1675 added "mellitus" to the word "diabetes" as a designation for the disease,
when he noticed the urine of a diabetic had a sweet taste (glycosuria).[83]
This sweet taste had
been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians.
Society and culture

Further information: List of films featuring diabetes
The 1989 "St. Vincent Declaration"[88][89]
was the result of international efforts to improve the care
accorded to those with diabetes. Doing so is important not only in terms of quality of life and life
expectancy, but also economically—expenses due to diabetes have been shown to be a major
drain on health—and productivity-related resources for healthcare systems and governments.
Several countries established more and less successful national diabetes programmes to improve
treatment of the disease.[90]
People with diabetes who have neuropathic symptoms such as numbness or tingling in feet or
hands are twice as likely to be unemployed as those without the symptoms.[91]
In 2010, diabetes-related emergency room (ER) visit rates in the United States were higher
among people from the lowest income communities (526 per 10,000 population) than from the
highest income communities (236 per 10,000 population). Approximately 9.4% of diabetes-
related ER visits were for the uninsured.[92]
Naming
The term "type 1 diabetes" has replaced several former terms, including childhood-onset
diabetes, juvenile diabetes, and insulin-dependent diabetes mellitus (IDDM). Likewise, the term
"type 2 diabetes" has replaced several former terms, including adult-onset diabetes, obesity-
related diabetes, and noninsulin-dependent diabetes mellitus (NIDDM). Beyond these two types,
there is no agreed-upon standard nomenclature.
Diabetes mellitus is also occasionally known as "sugar diabetes" to differentiate it from diabetes
insipidus.[93]
Other animals
Main articles: Diabetes in dogs and Diabetes in cats
In animals, diabetes is most commonly encountered in dogs and cats. Middle-aged animals are
most commonly affected. Female dogs are twice as likely to be affected as males, while
according to some sources, male cats are also more prone than females. In both species, all
breeds may be affected, but some small dog breeds are particularly likely to develop diabetes,
such as Miniature Poodles.[94]
The symptoms may relate to fluid loss and polyuria, but the course
may also be insidious. Diabetic animals are more prone to infections. The long-term
complications recognised in humans are much rarer in animals. The principles of treatment
(weight loss, oral antidiabetics, subcutaneous insulin) and management of emergencies (e.g.
ketoacidosis) are similar to those in humans.[94]

Latest Research

Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic
diseases in which the person has high blood glucose (blood sugar), either because insulin
production is inadequate, or because the body's cells do not respond properly to insulin, or
both. Patients with high blood sugar will typically experience polyuria (frequent urination),
they will become increasingly thirsty (polydipsia) and hungry (polyphagia).
Fast facts on diabetes
Here are some key points about diabetes. More detail and supporting information is in the
main article.
 Diabetes is a long-term condition that causes high blood sugar levels.
 In 2013 it was estimated that over 382 million people throughout the world had
diabetes (Williams textbook of endocrinology).
 Type 1 Diabetes - the body does not produce insulin. Approximately 10% of all
diabetes cases are type 1.
 Type 2 Diabetes - the body does not produce enough insulin for proper function.
Approximately 90% of all cases of diabetes worldwide are of this type.
 Gestational Diabetes - this type affects females during pregnancy.
 The most common diabetes symptoms include frequent urination, intense thirst
and hunger, weight gain, unusual weight loss, fatigue, cuts and bruises that do
not heal, male sexual dysfunction, numbness and tingling in hands and feet.
 If you have Type 1 and follow a healthy eating plan, do adequate exercise, and
take insulin, you can lead a normal life.
 Type 2 patients need to eat healthily, be physically active, and test their blood
glucose. They may also need to take oral medication, and/or insulin to control
blood glucose levels.
 As the risk of cardiovascular disease is much higher for a diabetic, it is crucial that
blood pressure and cholesterol levels are monitored regularly.
 As smoking might have a serious effect on cardiovascular health, diabetics
should stop smoking.

 Hypoglycemia - low blood glucose - can have a bad effect on the patient.
Hyperglycemia - when blood glucose is too high - can also have a bad effect on
the patient.
This information hub offers detailed but easy-to-follow information about diabetes. Should
you be interested in the latest scientific research on diabetes, please see our diabetes news
section.
There are three types of diabetes:
1) Type 1 diabetes
The body does not produce insulin. Some people may refer to this type as insulin-
dependent diabetes, juvenile diabetes, or early-onset diabetes. People usually develop
type 1 diabetes before their 40th year, often in early adulthood or teenage years.
Type 1 diabetes is nowhere near as common as type 2 diabetes. Approximately 10% of all
diabetes cases are type 1.
Patients with type 1 diabetes will need to take insulin injections for the rest of their life. They
must also ensure proper blood-glucose levels by carrying out regular blood tests and
following a special diet.
Between 2001 and 2009, the prevalence of type 1 diabetes among the under 20s in the
USA rose 23%, according to SEARCH for Diabetes in Youth data issued by the CDC
(Centers for Disease Control and Prevention). (Link to article)
More information on type 1 diabetes is available in our type 1 diabetes page.
2) Type 2 diabetes
The body does not produce enough insulin for proper function, or the cells in the body do
not react to insulin (insulin resistance).
Approximately 90% of all cases of diabetes worldwide are type 2.

Measuring the glucose level in
blood
Some people may be able to control their type 2 diabetes symptoms by losing weight,
following a healthy diet, doing plenty of exercise, and monitoring their blood glucose levels.
However, type 2 diabetes is typically a progressive disease - it gradually gets worse - and
the patient will probably end up have to take insulin, usually in tablet form.
Overweight and obese people have a much higher risk of developing type 2 diabetes
compared to those with a healthy body weight. People with a lot of visceral fat, also known
as central obesity, belly fat, or abdominal obesity, are especially at risk. Being
overweight/obese causes the body to release chemicals that can destabilize the body's
cardiovascular and metabolic systems.
Being overweight, physically inactive and eating the wrong foods all contribute to our risk of
developing type 2 diabetes. Drinking just one can of (non-diet) soda per day can raise our
risk of developing type 2 diabetes by 22%, researchers from Imperial College London
reported in the journal Diabetologia. The scientists believe that the impact of sugary soft
drinks on diabetes risk may be a direct one, rather than simply an influence on body weight.
The risk of developing type 2 diabetes is also greater as we get older. Experts are not
completely sure why, but say that as we age we tend to put on weight and become less
physically active. Those with a close relative who had/had type 2 diabetes, people of Middle
Eastern, African, or South Asian descent also have a higher risk of developing the disease.
Men whose testosterone levels are low have been found to have a higher risk of developing
type 2 diabetes. Researchers from the University of Edinburgh, Scotland, say that low
testosterone levels are linked to insulin resistance. (Link to article)

For more information on how type 1 and type 2 diabetes compare, see our article: the
difference between type 1 and type 2 diabetes.
More information on type 1 diabetes is available in our type 2 diabetes page.
3) Gestational diabetes
This type affects females during pregnancy. Some women have very high levels of glucose
in their blood, and their bodies are unable to produce enough insulin to transport all of the
glucose into their cells, resulting in progressively rising levels of glucose.
Diagnosis of gestational diabetes is made during pregnancy.
The majority of gestational diabetes patients can control their diabetes with exercise and
diet. Between 10% to 20% of them will need to take some kind of blood-glucose-controlling
medications. Undiagnosed or uncontrolled gestational diabetes can raise the risk of
complications during childbirth. The baby may be bigger than he/she should be.
Scientists from the National Institutes of Health and Harvard University found that women
whose diets before becoming pregnant were high in animal fat and cholesterol had a higher
risk for gestational diabetes, compared to their counterparts whose diets were low in
cholesterol and animal fats. (Link to article)
Diabetes symptoms

Symptoms of diabetes - by Mikael Häggström
See the next page of our article for a full list of possible diabetes symptoms.
What is prediabetes?
The vast majority of patients with type 2 diabetes initially had prediabetes. Their blood
glucose levels where higher than normal, but not high enough to merit a diabetes diagnosis.
The cells in the body are becoming resistant to insulin.
Studies have indicated that even at the prediabetes stage, some damage to the circulatory
system and the heart may already have occurred.
Diabetes is a metabolism disorder

Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the
way our bodies use digested food for energy and growth. Most of what we eat is broken
down into glucose. Glucose is a form of sugar in the blood - it is the principal source of fuel
for our bodies.
When our food is digested, the glucose makes its way into our bloodstream. Our cells use
the glucose for energy and growth. However, glucose cannot enter our cells without insulin
being present - insulin makes it possible for our cells to take in the glucose.
Insulin is a hormone that is produced by the pancreas. After eating, the pancreas
automatically releases an adequate quantity of insulin to move the glucose present in our
blood into the cells, as soon as glucose enters the cells blood-glucose levels drop.
A person with diabetes has a condition in which the quantity of glucose in the blood is too
elevated (hyperglycemia). This is because the body either does not produce enough insulin,
produces no insulin, or has cells that do not respond properly to the insulin the pancreas
produces. This results in too much glucose building up in the blood. This excess blood
glucose eventually passes out of the body in urine. So, even though the blood has plenty of
glucose, the cells are not getting it for their essential energy and growth requirements.
How to determine whether you have diabetes,
prediabetes or neither
Doctors can determine whether a patient has a normal metabolism, prediabetes or diabetes
in one of three different ways - there are three possible tests:
 The A1C test
- at least 6.5% means diabetes
- between 5.7% and 5.99% means prediabetes
- less than 5.7% means normal
 The FPG (fasting plasma glucose) test
- at least 126 mg/dl means diabetes
- between 100 mg/dl and 125.99 mg/dl means prediabetes
- less than 100 mg/dl means normal
An abnormal reading following the FPG means the patient has impaired fasting
glucose (IFG)

 The OGTT (oral glucose tolerance test)
- at least 200 mg/dl means diabetes
- between 140 and 199.9 mg/dl means prediabetes
- less than 140 mg/dl means normal
An abnormal reading following the OGTT means the patient has impaired glucose
tolerance (IGT)
Why is it called diabetes mellitus?
Diabetes comes from Greek, and it means a "siphon". Aretus the Cappadocian, a Greek
physician during the second century A.D., named the condition diabainein. He described
patients who were passing too much water (polyuria) - like a siphon. The word became
"diabetes" from the English adoption of the Medieval Latin diabetes.
In 1675, Thomas Willis added mellitus to the term, although it is commonly referred to
simply as diabetes. Mel in Latin means "honey"; the urine and blood of people with diabetes
has excess glucose, and glucose is sweet like honey. Diabetes mellitus could literally mean
"siphoning off sweet water".
In ancient China people observed that ants would be attracted to some people's urine,
because it was sweet. The term "Sweet Urine Disease" was coined.
Controlling diabetes - treatment is effective and
important
All types of diabetes are treatable. Diabetes type 1 lasts a lifetime, there is no known
cure. Type 2 usually lasts a lifetime, however, some people have managed to get rid of their
symptoms without medication, through a combination of exercise, diet and body weight
control.

Special diets can help sufferers of type 2 diabetes control the condition.
Researchers from the Mayo Clinic Arizona in Scottsdale showed that gastric bypass surgery
can reverse type 2 diabetes in a high proportion of patients. They added that within three to
five years the disease recurs in approximately 21% of them. Yessica Ramos, MD., said
"The recurrence rate was mainly influenced by a longstanding history of Type 2 diabetes
before the surgery. This suggests that early surgical intervention in the obese, diabetic
population will improve the durability of remission of Type 2 diabetes." (Link to article)
Patients with type 1 are treated with regular insulin injections, as well as a special diet and
exercise.
Patients with Type 2 diabetes are usually treated with tablets, exercise and a special diet,
but sometimes insulin injections are also required.
If diabetes is not adequately controlled the patient has a significantly higher risk of
developing complications.
Complications linked to badly controlled diabetes:
Below is a list of possible complications that can be caused by badly controlled diabetes:
 Eye complications - glaucoma, cataracts, diabetic retinopathy, and some others.
 Foot complications - neuropathy, ulcers, and sometimes gangrene which may
require that the foot be amputated

 Skin complications - people with diabetes are more susceptible to skin
infections and skin disorders
 Heart problems - such as ischemic heart disease, when the blood supply to the
heart muscle is diminished
 Hypertension - common in people with diabetes, which can raise the risk of
kidney disease, eye problems, heart attack and stroke
 Mental health - uncontrolled diabetes raises the risk of suffering from depression,
anxiety and some other mental disorders
 Hearing loss - diabetes patients have a higher risk of developing hearing
problems
 Gum disease - there is a much higher prevalence of gum disease among
diabetes patients
 Gastroparesis - the muscles of the stomach stop working properly
 Ketoacidosis - a combination of ketosis and acidosis; accumulation of ketone
bodies and acidity in the blood.
 Neuropathy - diabetic neuropathy is a type of nerve damage which can lead to
several different problems.
 HHNS (Hyperosmolar Hyperglycemic Nonketotic Syndrome) - blood glucose
levels shoot up too high, and there are no ketones present in the blood or urine. It
is an emergency condition.
 Nephropathy - uncontrolled blood pressure can lead to kidney disease
 PAD (peripheral arterial disease) - symptoms may include pain in the leg,
tingling and sometimes problems walking properly
 Stroke - if blood pressure, cholesterol levels, and blood glucose levels are not
controlled, the risk of stroke increases significantly
 Erectile dysfunction - male impotence.

 Infections - people with badly controlled diabetes are much more susceptible to
infections
 Healing of wounds - cuts and lesions take much longer
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knowledge center home » diabetes » diabetes symptoms
SymptomsOf Diabetes
 What is Diabetes?
 DiabetesSymptoms
 Statistics, Facts & Myths
 Diagnosis of Diabetes
 Type 1 Diabetes
 Type 2 Diabetes
 Diabetes Complications
 What is Insulin?
 Discovery of Insulin
 Famous Diabetics
 Treatments for Diabetes
 Self Monitoring
 Food Planning
 Exercise
 Hypoglycemia
 Hyperglycemia
 Taking Insulin
 Insulin Pumps
 Latest Research
Diabetes Symptoms
Statistics from the 2014 USA national diabetes fact sheet from the CDC's National Diabetes
Report.
29.1 million US children and adults (9.3% of the population) have diabetes. This is a
rise from 25.8 million (8.5%) in 2011.

Researchers from the Jefferson School of Population Health (Philadelphia, PA) published a
study which estimates that by 2025 there could be 53.1 million people with diabetes.
21 million people have been diagnosed with diabetes (a rise from 18.8 million in 2011).
About 8.1 million people with diabetes have not been diagnosed (a rise from 7 million in
2011). This equates to 27.8% of people with diabetes currently being undiagnosed.
Diagnosed and undiagnosed diabetes among people
aged 20 years or older, US, 2012
 About 86 million Americans aged 20 years or older have prediabetes.
 1.7 million people aged 20 years or more were newly diagnosed with diabetes in
2012.
 208,000 (0.25%) people younger than 20 years have diabetes.
 Approximately 1 in every 400 kids and teenagers has diabetes.
 12.3% of people aged 20+ years have diabetes; a total of 28.9 million individuals.

 25.9% of people aged 65+ years have diabetes; a total of 11.2 million people.
 13.6% of men have diabetes; a total of 15.5 million people (a rise from 11.8% in
2010).
 11.2% of women have diabetes; a total of 13.4 million people (a rise from 10.8 in
2010).
Diabetes in the UK
In the United Kingdom there are about 3.8 million people with diabetes, according to the
National Health Service. Diabetes UK, a charity, believes this number will jump to 6.2 million
by 2035, and the National Health Service will be spending as much as 17% of its health
care budget on diabetes by then.
Diabetes spreads in southeast Asia
Diabetes is rapidly spreading in Southeast Asia as people embrace American fast foods,
such as hamburgers, hot dogs, French fries and pizza. More Chinese adults who live in
Singapore are dying of heart disease and developing type 2 diabetes than ever before,
researchers from the University of Minnesota School of Public Health and the National
University of Singapore reported in the journal Circulation.
The authors found that Chinese adults in Singapore who eat American-style junk foods
twice a week had a 56% greater risk of dying prematurely form heart disease, while their
risk of developing type 2 diabetes rose 27%, compared to their counterparts who "never
touched the stuff". There was a 80% higher likelihood of dying from coronary heart disease
for those eating fast foods four times per week. (Link to article)
Some facts and myths about diabetes
Many presumed "facts" are thrown about in the paper press, magazines and on the internet
regarding diabetes; some of them are, in fact, myths. It is important that people with
diabetes, pre-diabetes, their loved ones, employers and schools have an accurate picture of
the disease. Below are some diabetes myths:
 People with diabetes should not exercise - NOT TRUE!! Exercise is important
for people with diabetes, as it is for everybody else. Exercise helps manage body
weight, improves cardiovascular health, improves mood, helps blood sugar

control, and relieves stress. Patients should discuss exercise with their doctor
first.
 Fat people always develop type 2 diabetes eventually - this is not true. Being
overweight or obese raises the risk of becoming diabetic, they are risk factors, but
do not mean that an obese person will definitely become diabetic. Many people
with type 2 diabetes were never overweight. The majority of overweight people do
not develop type 2 diabetes.
 Diabetes is a nuisance, but not serious - two thirds of diabetes patients die
prematurely from stroke or heart disease. The life expectancy of a person with
diabetes is from five to ten years shorter than other people's. Diabetes is a
serious disease.
 Children can outgrow diabetes - this is not true. Nearly all children with
diabetes have type 1; insulin-producing beta cells in the pancreas have been
destroyed. These never come back. Children with type 1 diabetes will need to
take insulin for the rest of their lives, unless a cure is found one day.
 Don't eat too much sugar, you will become diabetic - this is not true. A person
with diabetes type 1 developed the disease because their immune system
destroyed the insulin-producing beta cells. A diet high in calories, which can make
people overweight/obese, raises the risk of developing type 2 diabetes, especially
if there is a history of this disease in the family.
 I know when my blood sugar levels are high or low - very high or low blood
sugar levels may cause some symptoms, such as weakness, fatigue and extreme
thirst. However, levels need to be fluctuating a lot for symptoms to be felt. The
only way to be sure about your blood sugar levels is to test them regularly.
Researchers from the University of Copenhagen, Denmark showed that even
very slight rises in blood-glucose levels significantly raise the risk of ischemic
heart disease. (Link to article)
 Diabetes diets are different from other people's - the diet doctors and
specialized nutritionists recommend for diabetes patients are healthy ones;
healthy for everybody, including people without the disease. Meals should contain
plenty of vegetables, fruit, whole grains, and they should be low in salt and sugar,

and saturated or trans fat. Experts say that there is no need to buy special
diabetic foods because they offer no special benefit, compared to the healthy
things we can buy in most shops.
 High blood sugar levels are fine for some, while for others they are a sign of
diabetes - high blood-sugar levels are never normal for anybody. Some illnesses,
mental stress and steroids can cause temporary hikes in blood sugar levels in
people without diabetes. Anybody with higher-than-normal blood sugar levels or
sugar in their urine should be checked for diabetes by a health care professional.
 Diabetics cannot eat bread, potatoes or pasta - people with diabetes can eat
starchy foods. However, they must keep an eye on the size of the portions. Whole
grain starchy foods are better, as is the case for people without diabetes.
 One person can transmit diabetes to another person - NOT TRUE. Just like a
broken leg is not infectious or contagious. A parent may pass on, through their
genes to their offspring, a higher susceptibility to developing the disease.
 Only older people develop type 2 diabetes - things are changing. A growing
number of children and teenagers are developing type 2 diabetes. Experts say
that this is linked to the explosion in childhood obesity rates, poor diet, and
physical inactivity.
 I have to go on insulin, this must mean my diabetes is severe - people take
insulin when diet alone or diet with oral or non-insulin injectable diabetes drugs do
not provide good-enough diabetes control, that's all. Insulin helps diabetes
control. It does not usually have anything to do with the severity of the disease.
 If you have diabetes you cannot eat chocolates or sweets - people with
diabetes can eat chocolates and sweets if they combine them with exercise or eat
them as part of a healthy meal.
 Diabetes patients are more susceptible to colds and illnesses in general - a
person with diabetes with good diabetes control is no more likely to become ill
with a cold or something else than other people. However, when a diabetic
catches a cold, their diabetes becomes harder to control, so they have a higher
risk of complications.


Diagnosis of Diabetes
Accurate tests are available to doctors to definitively confirm a diagnosis of diabetes.
Before tests are conducted, a diagnosis may be suspected when patients report certain
symptoms. Doctors will evaluate these symptoms by asking questions about the patient's
medical history.1
Doctors may also carry out a physical examination, including checks for complications that
could have already developed - examining the feet for changes in sensation, for example.2
Testing can be part of routine screening for people at risk of the disease, who may show up
as having prediabetes. The US Department of Health and Human Services recommends
diabetes testing for anyone overweight at the age of 45 years and over, alongside anyone
under the age of 45 with one or more of the following risk factors:2,3
 Hypertension (high blood pressure)
 High cholesterol
 History of diabetes in the family
 African-American, Asian-American, Latino/Hispanic-American, Native American
or Pacific Islander background
 History of gestational diabetes (diabetes during pregnancy) or delivering a baby
over 9 lbs.
Blood tests for diabetes diagnosis

Diagnoses of diabetes are confirmed through 1 of 3 types of blood test.
One of three blood tests can be used to confirm a diagnosis of diabetes:2-5
 Fasting plasma glucose (FPG) levels - a blood test after 8 hours of no eating
 Glycosylated hemoglobin (HbA1c) - to measure a marker of the average blood
glucose level over the past 2-3 months
 Oral glucose tolerance testing (OGTT) - a test used less frequently that measures
levels before and 2 hours after consuming a sweet drink (concentrated glucose
solution).
Glycosylated hemoglobin is often abbreviated to A1C, and this blood test is also used in the
monitoring of diabetes management.2,5
To make an initial diagnosis, an HbA1c reading must be 6.5% or higher. An A1C
result between 5.7% and 6.4% indicates prediabetes and a risk of type 2 diabetes.2,5,6

The HbA1c is the preferred blood test for diagnosis because - while it is more expensive
than the FPG test - it has advantages, including:5
Urine tests for diabetes were once common but are no longer considered reliable.
 Greater convenience (no need for fasting)
 Less day-to-day variation during stress and illness.
When the fasting plasma glucose test is used to confirm symptoms, diabetes is diagnosed
at levels equal to or above 126 mg/dL (7.0 mmol/L).7
For oral glucose tolerance testing, the plasma glucose levels after 2 hours need to be equal
to or above 200 mg/dL (11.1 mmol/L) for a diabetes diagnosis.7
Another blood test is the random plasma glucose test - taken regardless of time and eating -
which diagnoses diabetes if the level is at least 200 mg/dL (11.1 mmol/L).7

Unless the clinical picture is clear, a positive blood test should also be repeated to rule out
laboratory error.
Urine tests for diabetes diagnosis
Urine tests are no longer used to make a diagnosis of diabetes, although they were once
common. Blood tests are used instead because urine tests are not sensitive or specific
enough and offer only a crude indication of high blood sugar levels.2,8
A urine sample may be used, however, to test for ketones, particularly in people with type 1
diabetes who exhibit certain symptoms. Here, the test can pick up ketoacidosis, a
complication of diabetes.2,6,8

Type 1 Diabetes
While type 2 diabetes is often preventable, type 1 diabetes mellitus is not.1
Type 1
diabetes is an autoimmune disease in which the immune system destroys cells in the
pancreas.
Typically, the disease first appears in childhood or early adulthood. Type 1 diabetes used to
be known as juvenile-onset diabetes or insulin-dependent diabetes mellitus (IDDM), but the
disease can have an onset at any age.2
Type 1 diabetes makes up around 5% of all cases of diabetes.3,4
What is type 1 diabetes?

Type 1 diabetes usually first appears in childhood or adolescence.
In type 1 diabetes, the pancreas is unable to produce any insulin, the hormone that controls
blood sugar levels.2,3
Insulin production becomes inadequate for the control of blood glucose levels due to the
gradual destruction of beta cells in the pancreas. This destruction progresses without notice
over time until the mass of these cells decreases to the extent that the amount of insulin
produced is insufficient.2
Type 1 diabetes typically appears in childhood or adolescence, but its onset is also possible
in adulthood.2
When it develops later in life, type 1 diabetes can be mistaken initially for type 2 diabetes.
Correctly diagnosed, it is known as latent autoimmune diabetes of adulthood.2
Causes of type 1 diabetes

The gradual destruction of beta cells in the pancreas that eventually results in the onset of
type 1 diabetes is the result of autoimmune destruction. The immune system turning against
the body's own cells is possibly triggered by an environmental factor exposed to people who
have a genetic susceptibility.2
Although the mechanisms of type 1 diabetes etiology are unclear, they are thought to
involve the interaction of multiple factors:2
 Susceptibility genes - some of which are carried by over 90% of patients with type
1 diabetes. Some populations - Scandinavians and Sardinians, for example - are
more likely to have susceptibility genes
 Autoantigens - proteins thought to be released or exposed during normal
pancreas beta cell turnover or injury such as that caused by infection. The
autoantigens activate an immune response resulting in beta cell destruction
 Viruses - coxsackievirus, rubella virus, cytomegalovirus, Epstein-Barr virus and
retroviruses are among those that have been linked to type 1 diabetes
 Diet - infant exposure to dairy products, high nitrates in drinking water and low
vitamin D intake have also been linked to the development of type 1 diabetes.
Life with type 1 diabetes

Health care professionals usually teach people with type 1 diabetes to self-manage the condition.
Type 1 diabetes always requires insulin treatment and an insulin pump or daily injections
will be a lifelong requirement to keep blood sugar levels under control. The condition used
to be known as insulin-dependent diabetes.3
After the diagnosis of type 1 diabetes, health care providers will help patients learn how to
self-monitor via finger stick testing, the signs of hypoglycemia, hyperglycemia and other
diabetic complications. Most patients will also be taught how to adjust their insulin doses.2
As with other forms of diabetes, nutrition and physical activity and exercise are important
elements of the lifestyle management of the disease.

Type 2 Diabetes
Type 2 is the most common form of diabetes, accounting for over 90% of all diabetes
cases.1,2

The number of adults diagnosed with diabetes in the US has risen significantly in the past
30 years, almost quadrupling from 5.5 million cases in 1980 to 21.3 million in 2012.1
Type 2 diabetes used to be known as adult-onset diabetes and noninsulin-dependent
diabetes mellitus (NIDDM), but the disease can have an onset at any age, increasingly
including childhood.2
What is type 2 diabetes?
Type 2 diabetes mellitus most commonly develops in adulthood and is more likely to occur
in people who are overweight and physically inactive.3
Unlike type 1 diabetes which currently cannot be prevented, many of the risk factors for type
2 diabetes can be modified. For many people, therefore, it is possible to prevent the
condition.4
The International Diabetes Foundation highlight four symptoms that signal the need for
diabetes testing:5
 Frequent urination
 Weight loss
 Lack of energy
 Excessive thirst.
To learn more, visit the Knowledge Center articles about symptoms or diagnosis.
Causes of type 2 diabetes
Insulin resistance is usually the precursor to type 2 diabetes - a condition in which more
insulin than usual is needed for glucose to enter cells.3
Insulin resistance in the liver results
in more glucose production while resistance in peripheral tissues means glucose uptake is
impaired.2

Obesity can lead to insulin resistance - often the precursor to the development of type 2 diabetes.
The impairment stimulates the pancreas to make more insulin but eventually the pancreas
is unable to make enough to prevent blood sugar levels from rising too high.3
Genetics plays a part in type 2 diabetes - relatives of people with the disease are at a higher
risk, and the prevalence of the condition is higher in particular among Native Americans,
Hispanic and Asian people.2
Obesity and weight gain are important factors that lead to insulin resistance and type 2
diabetes, with genetics, diet, exercise and lifestyle all playing a part. Body fat has hormonal
effects on the effect of insulin and glucose metabolism.2
Once type 2 diabetes has been diagnosed, health care providers can help patients with a
program of education and monitoring, including how to spot the signs of hypoglycemia,
hyperglycemia and other diabetic complications.2
As with other forms of diabetes, nutrition and physical activity and exercise are important
elements of the lifestyle management of the condition.

For more information on how type 1 and type 2 diabetes compare, read our article: the
difference between type 1 and type 2 diabetes.

Diabetes Complications
Even when diabetes is well controlled, it raises the risk of other conditions such as
heart disease, and poorly controlled diabetes can lead to serious complications.1-3
The good news is that diabetes prevention has greatly improved, leading to a drop in the
rates of five major complications - including death - from 1990-2010 in the US.4
Causes of diabetes complications
High blood glucose levels are damaging to blood vessels and can increase the likelihood of
them narrowing through atherosclerosis. This damage also leads to poor supply of blood to
nerves.1-3
Poorly controlled hyperglycemia persisting for years can lead to complications affecting
small blood vessels (microvascular complications), large blood vessels (macrovascular
complications) or both.2
The process by which vascular disease develops is complex and occurs via numerous
pathways that scientists continue to investigate.5
What complications are caused by diabetes?
Microvascular complications - those resulting from damage to small blood vessels - are the
most common complications of diabetes and include:2
 Retinopathy - disease of the eye
 Nephropathy - disease of the kidneys
 Neuropathy - disease of the nerves.
Macrovascular complications - those resulting from damage to large blood vessels -
include:2
 Angina pectoris and heart attack

 Transient ischemic attacks and strokes
 Peripheral arterial disease.
Diabetic retinopathy
People with diabetes should go for regular professional eye checks.
Diabetic retinopathy is an eye complication caused by disease of the tiny blood vessels
supplying the retina (the light-sensitive back of the eye).2,3
Early detection and preventive action are important. As symptoms do not appear before
damage is done, anyone with diabetes - whether type 1 or type 2 - should have their eyes
regularly checked by an optometrist or ophthalmologist.2,3,6
Most people with diabetic retinopathy do not lose their vision, but blindness is nonetheless a
risk. The key to prevention is tight control over blood sugar levels. Interventions are also
available for diabetic retinopathy, such as laser photocoagulation.2,6

Diabetic nephropathy
Diabetic nephropathy - kidney or renal disease - is another complication caused by damage
to small blood vessels.2
Diabetes is the cause of most cases of the most serious kidney disease - end-stage renal
disease.1
Nephropathy can also appear at other stages, from renal insufficiency through to
chronic renal failure. There is a progressive decline in kidney function in terms of the
glomerular filtration rate.2
Nephropathy is diagnosed by urine test and the primary treatment - as with other diabetes
complications - is tight control of blood sugar levels. In addition, blood pressure treatment
with drugs may be needed.2
Diabetic neuropathy
Diabetic neuropathy - a disease of nerves - is also a complication caused by damage to
small blood vessels. In this case, it involves capillaries supplying nerves.2
Foot complications

Diabetes can cause nerve damage in the feet. Wounds can go unnoticed and fail to heal properly.
Complications affecting the foot - often referred to as "diabetic foot" - result from
neuropathy, nerve damage that causes tingling sensations, burning or stinging pain,
weakness or loss of feeling.2,6
The nerves become damaged due to restricted blood supply.2
The phenomenon can also affect the hands, but it is the feet that are most commonly
affected. Because of the loss of sensation for heat, cold or pain, and a lack of attention
given to the feet, they are at risk from injury, wounds, blisters or ulcers going unnoticed. If
left unnoticed, this condition can lead to infection and even gangrene and potential
amputation.2,3,7
Nerve damage leads to skin changes, making the foot dry and prone to cracking or
peeling.2,7
Poor circulation to the feet caused by vessel narrowing can also mean that any
infections or wounds heal less readily.7

The key to preventing foot complications is to monitor the feet so that problems are spotted
at the first opportunity. Seeking medical attention for any problems is important, as is getting
the feet checked by a health care professional, such as a podiatrist, at least annually.2
Other
practical measures include:3
 Keeping the feet clean and dry
 Ensuring the nails are well-maintained
 Wearing socks and shoes that fit comfortably and do not rub or squeeze the feet.
Macrovascular complications
Disease of the large blood vessels caused by diabetes can lead to angina, transient
ischemic attacks or stroke, heart attack and peripheral arterial disease. Alongside
microvascular disease, macrovascular disease also contributes to the risk of the heart
disease cardiomyopathy.2
Screening, history and physical examination diagnose macrovascular disease, and
treatment includes tight control of blood sugar levels as well as lipid- and blood pressure-
lowering therapies. Other strategies include smoking cessation, aspirin and drugs known as
ACE inhibitors.2
Adults with diabetes are two-to-four times more likely to have heart disease or a stroke than
those without diabetes. A number of risk factors in people with diabetes contribute to
macrovascular complications:1
 High blood pressure
 Abnormal cholesterol and high triglyceride levels
 Obesity
 Lack of physical activity
 Smoking.
Prevention of diabetes complications
All the potential complications of diabetes can be prevented or controlled with tight glycemic
control, which means keeping HbA1C levels below 7%.2

Measures to keep control of glucose levels, in addition to drugs or insulin treatment, include
exercise and diet. Additionally, keeping control of blood pressure and lipid levels helps to
prevent complications of diabetes.2
As discussed above, close monitoring of health so that potential complications are spotted
at the first opportunity is also a preventive measure, including specific checks for the eyes
and feet.

Discovery of Insulin
The discovery of insulin was one of the most dramatic and important milestones in
medicine - a Nobel Prize-winning moment in science.
Witnesses to the first people ever to be treated with insulin saw "one of the genuine
miracles of modern medicine," says the author of a book charting its discovery.1
Starved and sometimes comatose patients with diabetes would return to life after receiving
insulin.
But how and when was the discovery made, and who made it?
How and when was insulin discovered?
The discovery of insulin did not come out of the blue; it was made on the back of a growing
understanding of diabetes mellitus during the nineteenth century.

Experiments involving the pancreas were key to the discovery of insulin. The beta cells of the
pancreas that produce insulin were discovered in 1869.
Diabetes itself had been understood by its symptoms as far back as the 1600s - when it
was described as the "pissing evile" - and the urination and thirst associated with it had
been recognized thousands of years before.
A feared and usually deadly disease, doctors in the nineteenth century knew that sugar
worsened diabetes and that limited help could be given by dietary restriction of sugar. But if
that helped, it also caused death from starvation.
Scientists observed the damaged pancreases of people who died with diabetes. In 1869, a
German medical student found clusters of cells in the pancreas that would go on to be
named after him.
Paul Langerhans had discovered the beta cells that produce insulin.
Other work in animals then showed that carbohydrate metabolism was impossible once the
pancreas was removed - the amount of sugar in the blood and urine rose sharply, and
death from diabetes soon followed.
In 1889, Oscar Minkowski and Joseph von Mering removed a dog's pancreas to study its
effects on digestion. They found sugar in the dog's urine after flies were noticed feeding off
it. In humans, doctors would once have diagnosed the condition by tasting the urine.

But as for the discovery of the "active ingredient" of the pancreas, numerous scientists
followed the work of Minkowski and von Mering in their attempts to extract it.
Between 1914 and 1916, it was the Romanian physiologist Nicolas C. Paulescu who first
extracted a pancreatic antidiabetic agent that treated dogs - but his experiments would be
overlooked in favor of work by other scientists.
Banting, Best, Collip and Macleod
It was in 1921 that Canadian physician Frederick Banting and medical student Charles H.
Best would be credited with discovering the hormone insulin in the pancreatic extracts of
dogs.
Banting and Best injected the hormone into a dog and found that it lowered high blood
glucose levels to normal. They then perfected their experiments to the point of grinding up
and filtering a dog's surgically tied pancreas, isolating a substance called "isletin."
The pair then developed insulin for human treatment with the help of Canadian chemist
James B. Collip and Scottish physiologist J.J.R. Macleod.
Macleod had been impressed with Banting and Best's work but wanted a retrial of the
evidence. He provided pancreases from cows to make the extract which was named
"insulin," and the procedures were repeated. Collip's role was to help with purifying the
insulin to be used for testing on humans.
Ultimately, the first medical success was with a boy with type 1 diabetes - 14-year-old
Leonard Thompson - who was successfully treated in 1922. Close to death before
treatment, Leonard bounced back to life with the insulin.
The news rapidly spread beyond Canada, and in 1923 the Nobel Committee decided to
award Banting and Macleod the Nobel Prize in Physiology or Medicine.

Treatment for Diabetes
Type 2 diabetes has a number of drug treatment options to be taken by mouth known
as oral antihyperglycemic drugs or oral hypoglycemic drugs.
Oral diabetes drugs are usually reserved for use only after lifestyle measures have been
unsuccessful in lowering glucose levels to the target of an HbA1c below 7.0%, achieved
through an average glucose reading of around 8.3-8.9 mmol/L (around 150-160 mg/dL).1-3

The lifestyle measures that are critical to type 2 diabetes management are diet and
exercise, and these remain an important part of treatment when pills are added.2,3
People with type 1 diabetes cannot use oral pills for treatment, and must instead take
insulin.
How do oral drugs lower glucose levels?
Metformin is the most widely used oral antihyperglycemic drug and reduces the amount of glucose
released by the liver into the bloodstream.
Oral antihyperglycemic drugs have three modes of action to reduce blood glucose levels:3
 Secretagogues enhance insulin secretion by the pancreas
 Sensitizers increase the sensitivity of the peripheral tissues to insulin
 Inhibitors impair gastrointestinal absorption of glucose.

Each class of antihyperglycemic drug has a different adverse event or safety profile, and
side effects are the main consideration when it comes to choosing a medication.
Possible side effects range from weight gain, through gastrointestinal ones such as
diarrhea, to pancreatitis and more serious problems. Hypoglycemia is also a possible
adverse event.2
What oral drugs are available for type 2 diabetes?
No one particular choice of oral hypoglycemic is considered the most effective form of
treatment - the decision over which drug to use is instead based on:1-3
 Consideration of the adverse side effects
 Convenience and overall tolerability
 Personal preference.
In reality, weighing up each drug is something to do in partnership with a prescriber -
guidelines partly drawn up by the American Diabetes Association list a great number of
advantages and disadvantages for each of the available drug treatments, including the
consideration of cost.2
The use of a single drug can be escalated to combination therapy with a second drug in an
effort to improve glycemic control.1,2
Metformin is usually the first treatment offered, however, and it is the most widely used oral
antihyperglycemic. Metformin is a sensitizer in the class known as biguanides; it works by
reducing the amount of glucose released by the liver into the bloodstream and increasing
cellular response to insulin. A metformin pill is usually taken twice a day.1-4
This drug is a low-cost antihyperglycemic with mild side effects that can include diarrhea
and abdominal cramping. Metformin is not associated with weight gain or hypoglycemia.2-4
Sulphonylureas are secretagogues that increase pancreatic insulin secretion. There are
several drug names in this class, including:1,3
 Chlorpropamide
 Glimepiride
 Glipizide

 Glyburide.
Again, the choice of drug is an individual one. In the case of sulphonylureas, the choice
depends on daily dosing and the level of side effects. These drugs are associated with
weight gain and hypoglycemia.2
Glitazones (also known as thiazolidinediones) are sensitizers - they increase the effect
of insulin in the muscle and fat and reduce glucose production by the liver.1-3
Two glitazones are available: pioglitazone and rosiglitazone. These drugs can have the side
effects of weight gain or swelling and are associated with increased risks of heart disease
and stroke, bladder cancer and fractures.
In the UK, rosiglitazone was withdrawn from the market over concerns about adverse
events.4
In 2015, it remains available in the US, with information on its safety provided by
the US Food and Drug Administration (FDA).
Alpha-glucosidase inhibitors are intestinal enzyme inhibitors that block the breakdown of
carbohydrates into glucose, reducing the amount absorbed in the gut.1,3,4
Available as acarbose and miglitol, they are not usually tried as first-line drugs because of
common side effects of flatulence, diarrhea and bloating, although these may reduce over
time.1,3,4
Dipeptidyl peptidase-4 (DPP4) inhibitors include alogliptin, linagliptin, saxagliptin and
sitagliptin.1
Also known as gliptins, DPP4 inhibitors have a number of effects, including stimulating
pancreatic insulin (by preventing the breakdown of the hormone GLP-1). They may also
help with weight loss through an effect on appetite.1-4
These drugs do not increase the risk of hypoglycemia. Mild possible side effects are nausea
and vomiting.1-4
Sodium-glucose co-transporter 2 (SGLT2) inhibitors include canagliflozin and
dapagliflozin. They work by inhibiting the reabsorption of glucose in the kidneys, causing
glucose to be excreted in the urine (glycosuria).1,3
SGLT2s may also cause modest weight loss. Side effects include urinary infection.1,3

Meglitinides include repaglinide and nateglinide. They stimulate the release of insulin by
the pancreas. Meglitinides are associated with a higher chance of hypoglycemia and must
be taken with meals three times a day. As a result, these drugs are less commonly used

Self Monitoring
Tight control of blood sugar levels is difficult to achieve. Levels can fall too low even
with the best adherence to demanding daily self-monitoring schedules.
The proportion of people in the US with a diagnosis of diabetes who undertake self-
monitoring of glucose has risen dramatically - from 36% in 1994 to 64% in 2010.1
All patients newly diagnosed with type 1 diabetes will receive training on how to do their
blood sampling and how to act on readings. Increasing numbers of people with type 2
diabetes - even those who do not need insulin treatment - are also recommended to self-
monitor their blood glucose levels.
What is blood glucose self-monitoring?

Self-monitoring requires a drop of blood and allows patients to improve their understanding of their
blood glucose levels.
The aim of self-monitoring is to collect detailed information about blood glucose levels over
time at multiple points. It helps maintain constant glucose levels and prevent hypoglycemia,
and allows the following to be scheduled accordingly:2-4
 The treatment regime/insulin doses
 Dietary intake
 Physical activity.
Such glycemic control is important in the prevention of the long-term complications of
diabetes.4,5
In addition to monitoring diabetes treatment effects and identifying blood sugar highs and
lows, self-monitoring is a strategy that guides overall treatment goals. Self-monitoring also

gives insight into how diet, exercise and other factors, such as illness and stress, affect
blood sugar levels.5,6
Self-monitoring helps patients improve their knowledge of glucose levels and the
effects of different behaviors on their blood glucose.5,6
Patients on glucose-lowering drugs can take their self-monitoring records to their health
care provider, allowing them to measure prescriptions accordingly and recommend any
adjustments to diet and exercise.4
Strict glycemic control in type 1 diabetes is difficult to achieve - even with good education on
self-monitoring, the most frequent measurement does not give enough information to avoid
hypoglycemia.7
Who should self-monitor blood glucose?
It was previously only people with insulin-treated diabetes - type 1 in particular - who would
be recommended to self-monitor their blood glucose levels.8
International guidelines now state that there is enough evidence for the benefit of glycemic
control to recommend self-monitoring to anyone with diabetes, including those with type 2
diabetes who do not need insulin treatment, as long as there is sufficient healthcare
support. Adequate support entails the following:4,8
 The monitoring is incorporated into an education program to promote appropriate
treatment adjustments according to blood glucose values
 There is shared management with health care providers to provide a clear set of
instructions for acting on results.
The type of diabetes determines how regularly self-measurement is needed. Type 1
diabetes demands several daily measurements whereas insulin-treated type 2 diabetes
needs only around two a day. If no insulin treatment is needed, less than daily
measurement may be sufficient.5
Target blood glucose levels
The overall goal of glycemic control for adults with diabetes has been set by the American
Diabetes Association, whose guidance is followed by health care providers. It states:9

 The HbA1c level (a marker of average glucose levels over recent months) should
be lowered to 7% to reduce the risk of diabetes complications
 If possible, and as long as hypoglycemia can be avoided, some individuals may
be able to target an HbA1c of 6.5%.
Less ambitious HbA1c targets (such as getting below 8%) are appropriate for some
patients, including those who have any of the following:9
 History of severe hypoglycemia
 Limited life expectancy
 Advanced diabetes complications
 Extensive coexisting conditions.
Less stringent targets may also be appropriate for people with long-standing diabetes who
find targets difficult in spite of disease management strategies.9
The 7% HbA1c level informs the equivalent self-monitoring targets that patients can aim for
(and again, less ambitious targets are appropriate for some patients):9
 Before meals (preprandial) - 70-130 mg/dL (3.9-7.2 mmol/L)
 After meals (postprandial, 1-2 hours after start of meal) - less than 180 mg/dL
(<10.0 mmol/L).
How is a blood glucose monitor used?
A glucose meter electronically reads a small sample of blood on a test strip. The blood is
usually drawn by a skin prick at the tip of a finger.5
Over 20 types of glucose meter are commercially available, varying in size, the amount of
blood needed and electronic memory and analysis features. While some enable graphs to
be computed, for many it is up to the user to keep meticulous records including details of
times, diet and exercise.3,5
Practical tips for blood glucose monitoring include:4

Self-monitoring of type 1 diabetes demands between four and eight finger-prick measurements
every day.
 Handle the meter and test strips with clean, dry hands
 Use the test strips specified for the meter and keep these in the original container

 Use a test strip only once and discard
 Strips can be calibrated with the meter for accuracy, and some meters require
coding with each new canister of strips
 Check for expiration dates
 Keep in a cool, dry place
 Take the meter to office visits for checks by providers.
Practical steps are also needed in preparation of the skin prick for a blood sample. The skin
site should be cleaned with warm, soapy water and dried, or an alcohol pad can be used.
Otherwise - if food has been handled recently, for example - false readings can occur.2,4
The lancet sizes vary and can be adjusted to prick the skin and produce the different
amounts of blood needed by various meters. Thinner and sharper lancets are typically the
most comfortable. Lancets should not be reused after single use.4
To reduce pain, the sides of the finger can be used and fingers can be rotated, including
any of the five digits instead of the index finger or thumb.4
While the most accurate measurements are enabled by the use of the fingertips or outer
palm, some meters allow the use of other sites such as the upper arms and thighs.4
When should glucose self-monitoring tests be done?
Individual cases of diabetes require different levels of blood glucose monitoring. The
frequency of testing can change for an individual as well; the frequency may need to be
intensified in the event of changes to medications, stress levels, diet or activity levels.2
Examples of the sort of information that can be provided by meter readings include
checking oral medicines or long-acting insulins through the use of nighttime fasting blood
glucose (FBG) readings, taken at around 3 or 4am.2
Test results from before eating can help to guide changes to meals or medicines, and those
obtained 1-2 hours following a meal are informative when learning how blood sugar levels
are affected by food.2
Tests at bedtime also help inform adjustments to diet or medications.2

Real-time continuous glucose monitoring
Continuous glucose monitoring overcomes the problem of taking numerous manual daytime
readings from skin pricks.
People with type 1 diabetes typically do between four and eight finger-prick measurements
each day, and rarely monitor nighttime blood glucose levels.5,7
Such self-monitoring can lead to rapid changes in blood glucose known as excursions,
including postprandial hyperglycemia, asymptomatic hypoglycemia and fluctuations
overnight.7
Real-time continuous glucose monitoring has been shown to be more effective than self
blood glucose measurement in reducing HbA1c in type 1 diabetes because it provides
detailed information on glucose patterns and trends.7
The major factor crucial to the success of the devices is motivation and compliance of the
user.7
The available continuous monitors - some of which are combined with insulin pumps -
consist of an electrochemical sensor placed under the skin and replaced every 3-7 days

Food Planning
Alongside exercise, a healthy diet is an important element of the lifestyle
management of diabetes, as well as being preventive against the onset of type 2
diabetes.
Maintaining a good diet is also a vital part of keeping tight control of blood sugar levels,
itself important for minimizing the risk of diabetes complications.1
The good news for people living with diabetes is that the condition does not preclude any
particular type of food or require an unusual diet - the goal is much the same as it would be
for anyone wishing to eat a healthy, balanced diet.2
What diet is best for diabetes?

Choose skim milk and low-fat dairy products to help reduce fat intake.
Having diabetes does not involve any particularly difficult dietary demands, and while
sugary foods obviously affect blood glucose levels, the diet does not have to be completely
sugar-free.2
Dietary concerns vary slightly for people with different types of diabetes. For people with
type 1 diabetes, diet is about managing fluctuations in blood glucose levels while for people
with type 2 diabetes, it is about losing weight and restricting calorie intake.3
For people with type 1 diabetes, the timing of meals is particularly important in terms of
glycemic control and in relation to the effects of insulin injection.3
In general, however, a healthy, balanced diet is all that is needed, and the benefits are not
confined to good diabetes management - they also mean good heart health.2,4
A healthy diet
typically includes a variety of fruits and vegetables, whole grains, low-fat dairy products,
skinless poultry and fish, nuts and legumes and non-tropical vegetable oils.4

The following are some general dietary tips for a healthy lifestyle:2-5
 Eat regularly - avoid the effects on glucose levels of skipping meals or having
delayed meals because of work or long journeys (take healthy snacks with you)
 Eat vegetables and fruits and eat them in place of high-calorie foods - a variety of
fresh, frozen and canned is good, but avoid high-calorie sauces and food
containing added salt or sugar
 Whole grains high in fiber are recommended as a healthy source of carbohydrate
Try drinking water or tea and coffee instead of sugary drinks and avoid adding sugar to
hot drinks.
 Eat pulses, a low-fat starchy source of protein and fiber, such as beans, lentils,
chickpeas and garden peas

 Reduce intake of saturated and trans fats by having poultry and fish without the
skin and cooked, for example, under the grill, rather than fried
 Take a similar approach to cooking red meat while reducing intake and looking for
the leanest cuts
 Eat fish twice a week or more, but avoid batters and frying - go for oily fish such
as salmon, mackerel, sardine, trout and herring, which are richsources of omega-
3
 Avoid partially hydrogenated vegetable oils and limit saturated fat and trans fat -
replace them with monounsaturated and polyunsaturated fats
 Dairy awareness helps reduce fat intake - select skim (fat-free) milk and low-fat
(1%) dairy products, reduce consumption of cheese and butter and swap out
creamy sauces for tomato-based ones
 Cut back on sugar by avoiding added sugars in drinks and foods - have tea and
coffee without sugar, avoid fruit that is canned in syrup and pay attention to food
labels
 Cut back on salt - prepare foods at home with little or no salt and avoid foods with
high sodium such as processed foods
 Cut back on portion sizes - be wary of amounts consumed when eating out
 Be wary of "diabetic" foods - they are of no particular benefit and can be
expensive
 Drink alcohol only in moderation - as a guide, no more than one drink a day for
women and no more than two for men.
Professional help with lifestyle changes for diabetes
In the US, the Community Preventive Services Task Force run diabetes prevention
programs that help with improving diet for people at risk of, or newly diagnosed with type 2
diabetes. The programs may include:6
 Goals toward weight loss

 Individual and group education sessions on diet and exercise
 Meetings with diet and exercise counselors
 Individually designed diet and exercise plans.
Participants in the national diabetes prevention program have access to a lifestyle coach to
learn more about healthy eating and exercise.6
Obesity, diabetes and diet
Obesity is a risk factor for type 2 diabetes, and obesity in people who already have diabetes
results in poor control of blood sugar, blood pressure and cholesterol levels.6
Another concern with being overweight or having obesity is that it can worsen many of the
complications of diabetes.6
Weight loss can be achieved by following the recommendations above and restricting the
intake of calories
Alongside diet, exercise is an important element of the lifestyle management of
diabetes, as well as being preventive against the onset of type 2 diabetes.
Exercise need not be hard work and can be effective if done in a way that is enjoyable.
Staying active simply through outdoor activities such as walking and gardening or through
favorite games such as tennis is a valid approach.1
Before embarking on any new exercise activity, it is worth discussing it first with a health
care professional, especially if there are any diabetes complications present. Starting slowly
is also important in with any new activity.1,2
Why is exercise important in diabetes?
Two main factors are behind the need to maintain regular physical exercise:3
 Exercise helps with weight loss
 Exercise is good for heart health, helping to prevent diabetes complications.

Physical activity also raises the use of glucose by muscles and so can lower blood glucose
levels. Regular activity can also help reduce the amount of insulin needed to control blood
sugar levels by improving the body's insulin efficiency.4
What exercise is best with diabetes?
People with diabetes should increase their level of exercise gently, building up to a
maximum level that remains comfortable.3
Although some experts consider aerobic exercise to be best, lower-intensity exercise such as
swimming can be just as beneficial.
In the US, the Community Preventive Services Task Force run diabetes prevention
programs that help with increasing exercise and improving diet for people at risk of, or
newly diagnosed with type 2 diabetes. These programs may include:5
 Goals toward weight loss

 Individual and group education sessions on diet and exercise
 Meetings with diet and exercise counselors
 Individually designed diet and exercise plans.
Some experts consider aerobic exercise to be best, in which the heart rate and rate of
breathing go up considerably.3
Lower-intensity exercise such as swimming is as much of an
option for keeping healthy as higher-impact exercise such as running, however.
The American Heart Association has an easy-to-remember general recommendation for
exercise goals - take part in 30 minutes of moderate exercise on 5 days of the week,
reaching a total of 150 minutes a week. In addition, on 2 days a week, some moderate-to-
high-intensity muscle strengthening activity is suggested.6
More intensive goals are recommended for lowering certain risk factors, but individuals with
diabetes should seek help with tailoring their exercise to meet their personal circumstances
and goals.3
Exercise and glucose control
Physical activity increases the use of glucose, so patients who experience symptoms of
hypoglycemia during exercise need to monitor their blood glucose and increase
carbohydrate intake or lower their insulin dose accordingly. Glucose levels need to be just
above normal ahead of starting an activity.3
If hypoglycemia occurs during vigorous exercise, it may be necessary to ingest
carbohydrates - around 5-15 grams of a simple sugar such as sucrose, for example.3
What's the best exercise for type 2 diabetes?
This video, by YourUpdate, discusses a randomized control trial that found that both aerobic
exercise and resistance exercise improved blood sugar control in people with type 2
diabetes.

Hypoglycemia
Hypoglycemia is a complication of diabetes treatment whereby blood sugar levels fall
too low.

Strict glycemic control is important for reducing the risk of other serious complications but it
also raises the risk of hypoglycemia.1
Hypoglycemia is an iatrogenic problem - a condition brought on by medical intervention.
Hypoglycemia is the most common complication of diabetes treatment with insulin.1
Causes of hypoglycemia
Hypoglycemia occurs when blood glucose levels fall below 4 mmol/L (72mg/dL).2,3
The symptoms of hypoglycemia are ultimately caused by glucose deprivation of the nerves.
There are two types of hypoglycemia symptoms: neurogenic and neuroglycopenic
symptoms.4
Neurogenic symptoms arise from the perception of physiological changes caused by the
involuntary nervous system's response to hypoglycemia, while neuroglycopenic symptoms
result from glucose deprivation of the brain.4
Symptoms of hypoglycemia
Hypoglycemia can be dangerous and its onset can be quick. As a result, it is important to
learn how to recognize its symptoms.1
Mild or moderate hypoglycemia can lead to symptoms including the following:1,2,4
 Headache
 Sweating, chills or clamminess
 Heart palpitations
 Lightheadedness or dizziness
 Blurred vision
 Agitation.
Other symptoms include:
 Trembling or shakiness
 Anxiety

 Hunger
 Paresthesias such as tingling or numbness in the lips or tongue
 Looking pale.
The neuroglycopenic symptoms can be the most severe and result from glucose deprivation
of the brain. These symptoms include:1,3,4
 Confusion
 A sensation of warmth
 Weakness or fatigue
 Severe cognitive failure
 Seizure or convulsions
 Coma.
Treatments for hypoglycemia
An episode of hypoglycemia can be treated quickly and effectively with 15-20 grams of
glucose.1-3

A tablespoon of honey can be used as fast-acting for an episode of hypoglycemia.
If glucose is not available, other fast-acting, simple carbohydrate alternatives include a
tablespoon of honey, sweets such as jelly beans and 250ml of a non-diet soft drink or fruit
juice .2,3
Around 15 minutes after administering the initial treatment, the patient should check their
blood glucose level if possible. If it is not over 4.4 mmol/L (80 mg/dL), another 15 grams of
glucose should be taken.1
In cases where there is unconsciousness or an inability to swallow, trained health care
professionals or carers can treat hypoglycemia by injecting either one milligram of glucagon
(which causes the liver to release glucose) under the skin or into the muscles, or 50 mL of a
50% dextrose solution (25 grams) into a vein.1,2

Diabetes mellitus type 1 and type 2 by mohammad yaser hussain

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