Ultimate Guide to Diabetes

It’s estimated that more than 30 million Americans suffer from some form of diabetes ¹.

Unfortunately, cases are on the rise, impacting the nation’s healthcare system and costing hundreds of billions of dollars in medical costs and lost productivity every year.

Here’s what you should know about what diabetes is, how it is diagnosed, risks and genetic factors, how to treat it, and more.

What is Diabetes?

Diabetes is a disease that occurs when your blood glucose is too high. Blood glucose, also known as blood sugar, is your main source of energy. It comes from the food you eat ².

Insulin is a hormone produced by your pancreas that helps extract glucose from food so it can get into your cells and be used for energy.

With diabetes, your body may not produce enough insulin or none at all, or your body may not efficiently use the insulin it produces.

The glucose stays in your blood and doesn’t reach your cells. When you have excess glucose in your cells for extended periods of time, it can lead to a number of health problems.

Almost 10% of the U.S. population has some form of diabetes ³, making it a major societal health issue.

It is especially prevalent in people over 65, with estimates that diabetes affects 1 in 4 seniors ⁴.

The Financial Impacts of Diabetes

Aside from the medical toll of diabetes, the financial impacts of diabetes are significant as well:

• In 2018, the American Diabetes Association released research showing that the total costs of diabetes increased to $327 billion for 2017, a 26% rise in just five years. This included $237 billion in direct medical costs and an additional $90 billion in reduced productivity.

• The research also revealed that on average, people with diagnosed diabetes have medical expenditures 2.3 times higher than they would otherwise have without diabetes. On average, people diagnosed with diabetes have an average of $16,752 in medical costs per year, with about $9,601 attributed to diabetes.

• Indirectly, diabetes also results in a loss of $3.3 billion due to increased employee absenteeism, another $27 billion in reduced productivity for employees on the job, a loss of more than $37 billion as a result of the inability to work due to a disease-related disability, and $20 billion in lost productive capacity due to early mortality.

• About 2/3rds of paying for the cost to treat diabetes is provided by the government, including Medicare, Medicaid and the military, among others. The remaining amount is paid for by private insurance or by those who are uninsured.

• The top four states for diabetes treatment costs are:
  • California ($39.5 billion)
  • Texas ($25.6 billion)
  • Florida ($24.80 billion)
  • New York ($21.2 billion)

Types, Causes and Symptoms of Diabetes

More than 90% of cases of diabetes in adults are diagnosed as type 2 diabetes ⁵. However, there are many forms of the disease:

Type 1 diabetes

If you have type 1 diabetes, your body does not make insulin. Type 1 diabetes usually develops in children and young adults although it can appear at any age.

With type 1 diabetes, your immune system attacks and destroys the cells in your pancreas that make insulin.

The pancreas stops making insulin which means that glucose can’t get into your cells causing your blood glucose to rise above normal.

As a result, if you have type 1 diabetes you need to take insulin every day to stay alive.

Only about 5% of people with diabetes in the United States have type 1 diabetes.

Many experts believe that type 1 diabetes is caused by genetic factors as well as certain environmental issues.

Research is still underway to try and develop a more accurate cause for this form.

Symptoms of type 1 diabetes can come on suddenly, within a matter of days or weeks, and can lead to serious health problems.

Those symptoms often include:

• increased thirst and urination
• increased hunger
• blurred vision
• fatigue
• unexplained weight loss
• numbness or tingling in the feet or hands
• sores that do not heal
• unexplained weight loss

Another early onset symptom that is a life-threatening condition is diabetic ketoacidosis (DKA).

It occurs when the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones.

When ketones are produced too quickly, they can build up in the blood and become toxic by making a person’s blood become acidic.

DKA is an early onset symptom for someone who has not been diagnosed with type 1 diabetes.

However, if someone has already been diagnosed, DKA can occur as a result of infection, injury, a serious illness, missing doses of insulin or undergoing surgery.

Symptoms of DKA can include:

• breath that smells fruity
• dry or flushed skin
• nausea or vomiting
• stomach pain
• trouble breathing
• trouble paying attention or feeling confused

DKA is a life-threatening. If symptoms of DKA are present, it’s imperative to get emergency treatment as soon as possible.

Type 2 diabetes

Type 2 diabetes is the most common form of diabetes and occurs when blood glucose is too high.

With type 2 diabetes, your body doesn’t make enough insulin or doesn’t use the insulin efficiently meaning that glucose cannot be transferred into your cells to be used for energy.

Too much glucose stays in your blood and not enough of it reaches your cells where it is needed.

You can develop type 2 diabetes at any age, but it more often occurs in middle-aged or older people.

You are more likely to develop type 2 diabetes if you are over 45, obese and have a family history of diabetes.

It is also more common in African Americans, Hispanic/Latinos, American Indians, Asian Americans, and Pacific Islanders.

In addition, you’re more likely to develop type 2 diabetes if you have high blood pressure or are physically inactive.

You are also more at risk for type 2 diabetes if you have had gestational diabetes or prediabetes. Genetics and insulin resistance play a role in developing type 2 diabetes as well.

Extra weight sometimes causes insulin resistance and is common in people with type 2 diabetes.

The location of body fat also makes a difference. Extra belly fat is linked to insulin resistance and to type 2 diabetes.

To see if your weight puts you at risk for type 2 diabetes, check out the following Body Mass Index Chart ⁶.

Symptoms of type 2 diabetes can come on over a number of years and may include:

• increased thirst and urination
• increased hunger
• feeling tired
• blurred vision
• numbness or tingling in the feet or hands
• sores that do not heal
• unexplained weight loss

Some people do not even know they have type 2 diabetes until other health problems develop and a diagnosis is made through a blood test.

Gestational diabetes

Gestational diabetes can develop in some women when they are pregnant and can cause health problems for both the mother and the baby.

Symptoms may be mild or not present at all. It is believed that hormonal changes during pregnancy can make it more difficult for the body to use insulin.

Extra weight and a genetic predisposition to develop diabetes may also be contributing factors to the onset of gestational diabetes.

The most common symptoms are being thirstier than normal or having to urinate more frequently.

Doctors normally order tests for gestational diabetes between 24 and 28 weeks of pregnancy.

These tests will include a glucose challenge test and the oral glucose tolerance test.

Depending on the results of these tests and a mother’s ability to manage gestational diabetes through eating healthy and remaining active, insulin may or may not be needed as the pregnancy progresses.

The good news is that most of the time, this type of diabetes goes away after the baby is born.

But if you had gestational diabetes, you are more likely to develop type 2 diabetes later in life.

Your child is also more likely to become obese or develop type 2 diabetes as well.

Prediabetes

Prediabetes is a condition where glucose levels in the blood are higher than normal, but not high enough to be diagnosed as type 2 diabetes.

It’s estimated that about 1 of every 3 adults in the United States has prediabetes. About 90% of those with prediabetes don’t even know they have it ⁷.

Prediabetes leads to an increased risk of developing type 2 diabetes, strokes and heart attacks ⁸.

You can have prediabetes for many years, but it may be undetected until other health problems present themselves.

However, there are many risk factors for prediabetes and if you have them, it is wise to be tested. Those risk factors include ⁹:

• Being overweight
• Being 45 years or older
• Having a parent, brother, or sister with type 2 diabetes
• Being physically active less than 3 times a week
• If you have ever had gestational diabetes or given birth to a baby that weighed more than 9 pounds
• Having polycystic ovary syndrome

By following a healthier diet and getting more exercise, it may be possible to reverse prediabetes.

A lifestyle change program offered through the CDC-led National Diabetes Prevention Program can help you make those changes with lasting success.

Monogenic diabetes

Type 1 and type 2 diabetes are considered polygenic, meaning they are related to a change or a defect in multiple genes.

Polygenic forms of diabetes often run in families. Doctors diagnose polygenic forms of diabetes by testing blood glucose.

Monogenic diabetes is rare and results from changes or mutations in a single gene. This form of diabetes accounts for anywhere from 1 to 4 percent of all diabetic cases.

In most cases of monogenic diabetes, the gene mutation is inherited from one or both parents.

At other times, the gene mutation develops spontaneously, meaning that the mutation is not carried by either of the parents.

Neonatal diabetes mellitus (NDM) and maturity-onset diabetes of the young (MODY) are the two main forms of monogenic diabetes.

NDM occurs in newborns and young infants and is considered quite rare since in only appears in 1 out of every 400,000 infants in the U.S.

Most fetuses with NDM do not grow well in the womb, and newborns with NDM are much smaller than those of the same gestational age in what is known as intrauterine growth restriction

It is often misdiagnosed as type 2 diabetes. The best way to confirm or deny monogenic diabetes is through genetic testing which may also be conducted on other family members as well.

MODY is much more common than NDM and usually first occurs in adolescence or early adulthood.

It accounts for up to 2 percent of all cases of diabetes in the United States for people 20 and younger.

A number of different gene mutations have been shown to cause MODY.

The resulting high blood glucose levels can damage body tissues, particularly the eyes, kidneys, nerves, and blood vessels.

Cystic fibrosis-related diabetes

As the name implies, cystic fibrosis-related diabetes (CFRD) is common in people with cystic fibrosis (CF).

People who have CF produce a thick and sticky mucus that causes scarring in the pancreas.

When scarring takes place, the pancreas is not able to produce normal amounts of insulin. This leads to insulin deficiency.

Many people do not even know they have CFRD until they are tested for diabetes. People with CF are often tested for CFRD every year after they turn 10 years old.

Like other forms of diabetes, people with CFRD will have increased amounts of thirst and urination as well as weight loss, excessive fatigue and a loss in lung function.

Diabetes insipidus

Diabetes insipidus is completely different from type 1 or type 2 diabetes. It does not affect insulin or the way that the body uses blood sugar.

Instead, diabetes insipidus results from a malfunction in the pituitary gland and affects the production of the hormone vasopressin.

This changes the balance of water in the body.

There are two types of diabetes insipidus:

• Nephrogenic diabetes insipidus, a genetic condition that develops after a parent has passed on a genetic mutation.
• Neurohypophyseal diabetes insipidus, which is partly hereditary and genetic, but it can also stem from other factors, such as an injury or a tumor.

A person with diabetes insipidus can become dehydrated very easily.

They will need to drink lots of water and urinate frequently or they could suffer from low blood pressure, confusion, seizures and possibly a coma.

Other causes of diabetes

There are also other less common conditions that can lead to diabetes as well.

In addition to monogenic diabetes and cystic fibrosis as genetic causes of diabetes, a genetic-based iron overload disease called hemochromatosis causes the body to store too much iron.

If left untreated, it can build up in the pancreas and other organs, causing damage and impairing the ability to produce insulin.

There are also several hormonal diseases that can also cause insulin resistance and diabetes:

• Cushing’s syndrome occurs when the body produces too much cortisol—a.k.a., the “stress hormone.”
• Acromegaly occurs when the body produces too much growth hormone.
• Hyperthyroidism occurs when the thyroid gland produces too much thyroid hormone.

Inflammation to the pancreas (pancreatitis), pancreatic cancer, and trauma can all harm pancreatic cells needed to produce insulin, limiting or completely causing insulin to not be produced.

In cases where a damaged pancreas is removed, the loss of cells will also result in the onset of diabetes.

Food Choices and Diabetes

You can control diabetes to some degree based on the food choices you make.

You may be able to still eat your favorite foods, just less frequently and in smaller portions.

Working with your doctor and a nutritionist, you should be able to put together a diet that meets your needs while being responsible in minimizing the impacts of diabetes.

In general, you need to eat a variety of foods from all food groups for optimal health. Focus on the following general guidelines:

• Vegetables. Nonstarchy choices include broccoli, carrots, greens, peppers, and tomatoes. Starchy veggies include potatoes, corn, and green peas.
• Fruits. Eat oranges, melon, berries, apples, bananas, and grapes.
• Grains. Make half of your grains for the day whole grains. This will include wheat, rice, oats, cornmeal, barley, and quinoa that can be found in bread, pasta, cereal, and tortillas.
• Proteins. Includes choices such as lean meat, skinless chicken and turkey, fish, eggs, nuts, dried beans and certain peas (chickpeas and split peas), and meat substitutes such as tofu.
• Dairy. Choose low fat or nonfat milk, yogurts and cheeses.

You can learn more about food groups at the U.S. Department of Agriculture’s ChooseMyPlate.gov.

Limit foods that are high in saturated fat and trans fat, foods with a high salt content, sweets such as candy, ice cream and baked goods, and all types of beverages with added sugar.

Drink water whenever possible. Also use oils when cooking food instead of butter, cream, shortening, lard, or stick margarine.

Limit your alcohol intake. Have no more than one drink a day if you’re a woman or two drinks a day if you’re a man.

It’s also best to eat some food when you drink alcohol to help regulate your glucose levels.

There are also some additional excellent resources at Healthline.com for specific ideas about what you can enjoy and what to avoid if you have diabetes.

The 21 Best Snack Ideas If You Have Diabetes

11 Foods to Avoid With Diabetes

Four Food Choices That Greatly Increase Your Diabetes Risk

When Should I Eat if I Have Diabetes?

It depends. Some people need to eat at approximately the same time every day. Others have more flexibility.

Depending on your diabetes medicines or type of insulin, you may need to eat the same amount of carbohydrates at the same time each day.

If you take insulin at mealtimes, your eating schedule can be more flexible.

Your blood glucose level could drop too low if you take certain diabetes medications and you skip a meal.

You need to strictly follow the regimen your doctor lays out for you to avoid unnecessary medical events.

Is Diabetes Genetically Inherited?

In some cases, it appears that diabetes is passed on from one generation to the next. But there is no simple and clearly defined pattern as to how this happens.

Although type 1 and type 2 diabetes have different causes, there are two factors that are common to both.

A person may inherit a genetic predisposition to develop diabetes. This will be followed by something in a person’s environment that will trigger it.

The genetic link by itself is not enough. One of the ways this is substantiated is by examining identical twins.

Identical twins have identical genes. But when one twin has type 1 diabetes, the other gets the disease at most only half the time.

When one twin has type 2 diabetes, the other's risk is at most 3 in 4 ¹⁰.

In addition to genetic causes, scientists also believe that viruses may be the actual trigger for type 1 diabetes ¹¹.

Type 2 diabetes may be triggered by obesity, insulin resistance, and a host of other environmental issues.

Also, a family history of diabetes makes it more likely that a woman will develop gestational diabetes and this also suggests that genes play a role.

From a genetic standpoint, it appears that diabetes also runs in families and more often in certain racial or ethnic groups, including:

• African Americans
• Alaska Natives
• American Indians
• Asian Americans
• Hispanics/Latinos
• Native Hawaiians
• Pacific Islanders

Genetic testing for monogenic diabetes analyzes DNA for changes in the genes that cause monogenic diabetes.

Abnormal results can show if the gene responsible for diabetes in a particular individual is present or if someone is likely to develop a monogenic form of diabetes in the future.

Genetic testing can be an important element in determining the most appropriate treatment for people with monogenic diabetes.

Testing also helps family planning by understanding the risk of having a child with monogenic diabetes if a mother, father or family members have monogenic diabetes.

Most forms of NDM and MODY are caused by autosomal dominant mutations.

This means that diabetes can be passed on to children when only one parent carries or has the disease gene.

In most forms of MODY, a parent with MODY has a 50% chance of having a child with the disease.

There are also autosomal recessive forms of monogenic diabetes--a mutation must be inherited from both parents. In this instance, a child has a 25% chance of having monogenic diabetes.

For more information on genetic causes of diabetes

More information about the genes that cause NDM and MODY, the types of mutations responsible for the disease (autosomal dominant, autosomal recessive, X-linked, etc.), and clinical features can be found in the American Diabetes Association Standards of Medical Care in Diabetes.

To learn more about the genetics of all forms of diabetes, the National Institutes of Health has published The Genetic Landscape of Diabetes.

It is written for healthcare professionals and for people with diabetes interested in learning more about the disease.

Diabetes Risk Factors and Tests

There are a number of risk factors for type 2 diabetes. Some of these can be acted upon to reduce the chance of contracting diabetes.

You are more likely to develop type 2 diabetes if you ¹²:

• are overweight or obese
• are age 45 or older
• have a family history of diabetes
• are African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander
• have high blood pressure
• have a low level of HDL cholesterol, or a high level of triglycerides
• have a history of gestational diabetes or gave birth to a baby weighing 9 pounds or more
• are not physically active
• have a history of heart disease or stroke
• have depression
• have polycystic ovary syndrome (PCOS)
• have acanthosis nigricans, a dark, thick, and velvety skin around your neck or armpits

About 14% of all pregnancies result in gestational diabetes ¹³. That’s why your doctor will order a diabetes test for you in the 24th to 28th week of pregnancy.

You can also do some legwork on your own to determine if you might have an increased risk for getting diabetes, or possibly have it and not know it.

One in four Americans with diabetes has it and doesn’t know it.

Take the American Diabetes Association Diabetes Risk Test to see if you are at risk for type 2 diabetes.

A PDF version of the test is also available here.

Creating a family health history is an important risk factor for better understanding indicators of a number of diseases, including type 2 diabetes.

The National Diabetes Education Program (NDEP) encourages families to share information about their health history - especially when it comes to diabetes.

Knowing your family health history is important because it gives you and your health care team information about your risk for type 2 diabetes and other health problems.

You can start a family dialog about diabetes with these questions:

• Does anyone in the family have type 2 diabetes?
• Has anyone in the family been told they might get diabetes?
• Has anyone in the family been told they need to lower their weight or increase their physical activity to prevent type 2 diabetes?
• Did your mother get gestational diabetes when she was pregnant?

Knowing that there may be an increased risk is the first step in taking preventative measures, including a number of lifestyle modifications.

Diabetes in Children

For the longest time, type 1 diabetes was the most common form of diabetes in children and teens. But in more recent years, a higher percentage are now getting type 2 diabetes.

Experts attribute this to a number of factors including obesity, poor diets, overeating, and too much time spent in front of electronics at the expense of fresh air and exercise.

Unlike type 1 diabetes, type 2 is seldom diagnosed in children younger than 10.

A comprehensive study done a few years ago detected differences in the rates for male and female youths.

For type 1 diabetes, the rate rose more in males. For type 2 diabetes, the rate increased more in females.

The U.S. National Library of Medicine’s MedlinePlus website offers a wealth of information on diabetes in children and teens, including statistics, treatments, clinical trials, and advice and guidelines for parents on how to better manage diabetes in children who have been diagnosed.

Testing and Diagnosis of Diabetes

To confirm a diagnosis of diabetes, you will need to be tested by your healthcare professional. You cannot make the determination on your own. Over the counter offerings will not allow you to make an accurate assessment.

Get tested for type 1 diabetes if symptoms present themselves or if you have a family history of type 1 diabetes.

Experts recommend routine testing for type 2 diabetes if you are 45 or older, or between 19 and 44 and have one or more diabetes risk factors.

Testing is also recommended for any woman who has had gestational diabetes as well.

Health care professionals most often use the fasting plasma glucose (FPG) test or the A1C test to diagnose diabetes. In some cases, they may use a random plasma glucose (RPG) test.

Pregnant women may have the glucose challenge test, the oral glucose tolerance test, or both.

Potential Complications of Diabetes

Over time, diabetes can lead to:

• heart disease
• stroke
• kidney disease
• eye problems
• dental disease
• nerve damage
• circulatory problems
• foot problems
• amputation
• diabetic neuropathy
• low vision and blindness
• gum disease and dry mouth
• sexual and bladder problems
• cancer
• dementia

Sometimes certain medicines can harm insulin-producting cells or disrupt the way insulin works. These include:

• niacin, a type of vitamin B3
• certain types of diuretics/water pills
• anti-seizure drugs
• psychiatric drugs
• drugs to treat human immunodeficiency virus
• pentamidine, a drug used to treat a type of pneumonia
• glucocorticoids—medicines used to treat inflammatory illnesses such as rheumatoid arthritis , asthma , lupus , and ulcerative colitis
• anti-rejection medicines, used to help stop the body from rejecting a transplanted organ
• Statins, which are medicines to reduce LDL cholesterol levels, can slightly increase the chance that you’ll develop diabetes. Statins help protect you from heart disease and stroke so the strong benefits of taking statins outweigh the small chance that you could develop diabetes.

Can Diabetes Kill You If Untreated?

Yes.

If left untreated, diabetes can cause heart disease, stroke, kidney failure, high blood pressure and other related conditions that can prove fatal.

To avoid or delay the onset of these serious illnesses, you must keep your blood sugar levels under tight monitoring, eat healthy, get regular exercise, and don’t smoke.

You can cut your risk of life-threatening complications by as much as 75% if you do so ¹⁴.

Treatment Options for Diabetes

In addition to taking diabetic medications such as insulin, there are several other things you can do to mitigate the effects of the disease.

• Take the A1C test that will show your average blood glucose level over the past 3 months. The A1C goal for many people with diabetes is below 7 percent.
• Monitor your blood pressure with the of keeping it at or below 140/90 mm Hg.
• Keep your good and bad cholesterol in check. Ask your health care team what your cholesterol numbers should be.
• Stop smoking! Doing so will lower your risk for heart attack, stroke, kidney disease, diabetic eye disease, and amputation.
• Follow your diabetes meal plan.
• Get exercise and stress relief on a regular basis. Try to work up to 30 minutes or more of physical activity on most days of the week.
• Take your medicines. Don’t skip doses for diabetes and other related problems. You need to be consistent for the medicines to be as effective as possible.
• Monitor your blood glucose levels daily.
• Work closely with your doctor and other healthcare professionals. A healthcare team can have many possible members:
  • an endocrinologist for more specialized diabetes care
  • a registered dietitian, also called a nutritionist
  • a nurse
  • a certified diabetes educator
  • a pharmacist
  • a dentist
  • an eye doctor
  • a podiatrist, or foot doctor, for foot care
  • a social worker, who can help you find financial aid for treatment and community resources
• Get counseling to deal with the psychological effects of diabetes, if needed.

Can Diabetes be Reversed or Cured?

Once you have type 1 diabetes, you will have it for life. You can mitigate or completely reverse the impacts of type 2 diabetes by following all prescribed treatment regimens.

In addition to taking insulin and following lifestyle changes, you can possibly be a good candidate for more radical forms of treatment such as bariatric surgery, artificial pancreas, or pancreatic islet transplantation

There is no clear proof exists that taking supplements such as vitamins, minerals, herbs, or spices can help manage diabetes, so be careful about alternative therapies promoting a cure.

You may need supplements if you cannot get enough vitamins and minerals from foods, but be sure to talk with your doctor first since some can cause side effects or affect how your medicines work.

The Prognosis for a Person with Diabetes

Just like the disease itself, people who suffer from diabetes can share a wide range of prognoses.

Part of the prognosis will depend on the type of diabetes, how quickly it is diagnosed, how aggressive a patient is in treating it, whether lifestyle factors can be mitigated and a slew of other factors.

The good news is that because diabetes affects so many people, there is a considerable amount of resources being applied to the treatment of this disease.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research funding for diabetes research, including clinical trials.

Clinical trials are at the heart of all medical advancements, and look at new ways to prevent, detect, or treat disease.

Scientists are conducting research to learn more about diabetes, including the following studies:

• The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) is following more than 5,000 people across the country who have type 2 diabetes to find out which combination of two diabetes medicines is best for blood glucose management; has the fewest side effects; and is the most helpful for overall health in long-term diabetes treatment.

• TrialNet is conducting research studies around the world, including risk screening for relatives of people with type 1 diabetes, monitoring for people at risk, and innovative clinical trials aimed at slowing down or stopping the disease.

In addition, a list of selected clinical trials are currently open and recruiting and you may want to consider participation:

• Type 1 diabetes —includes studies funded by the NIH or other U.S. Government agencies
• Type 2 diabetes —includes studies funded by the NIH or other U.S. Government agencies
• Gestational diabetes —includes studies funded by the NIH; other U.S. Government agencies; and individuals, universities, or other organizations

You can also search www.ClinicalTrials.gov to find studies on other types of diabetes or on specific conditions linked to diabetes.

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