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Diabetes types and treatments

What are the different types of diabetes?

Diabetes is a group of diseases in which the body doesn’t produce enough or any insulin, doesn’t properly use the insulin that is produced, or exhibits a combination of both. When any of these things happens, the body is unable to get sugar from the blood into the cells. That leads to high blood sugar levels.

Glucose, the form of sugar found in your blood, is one of your main energy sources. A lack of insulin or resistance to insulin causes sugar to build up in your blood. This can lead to many health problems.

The three main types of diabetes are:

  • type 1 diabetes
  • type 2 diabetes
  • gestational diabetes

Diabetes types and treatments

What causes diabetes?

Type 1 diabetes

Type 1 diabetes is believed to be an autoimmune condition. This means your immune system mistakenly attacks and destroys the beta cells in your pancreas that produce insulin. The damage is permanent.

What prompts the attacks isn’t clear. There may be both genetic and environmental reasons. Lifestyle factors aren’t thought to play a role.

Type 2 diabetes

Type 2 diabetes starts as insulin resistance. This means your body can’t use insulin efficiently. That stimulates your pancreas to produce more insulin until it can no longer keep up with demand. Insulin production decreases, which leads to high blood sugar.

The exact cause of type 2 diabetes is unknown. Contributing factors may include:

  • genetics
  • lack of exercise
  • being overweight

There may also be other health factors and environmental reasons.

Gestational diabetes

Gestational diabetes is due to insulin-blocking hormones produced during pregnancy. This type of diabetes only occurs during pregnancy.

What are the symptoms?

General symptoms of diabetes include:

  • excessive thirst and hunger
  • frequent urination
  • drowsiness or fatigue
  • dry, itchy skin
  • blurry vision
  • slow-healing wounds

Type 2 diabetes can cause dark patches in the folds of skin in your armpits and neck. Since type 2 diabetes often takes longer to diagnose, you may feel symptoms at the time of diagnosis, like pain or numbness in your feet.

Type 1 diabetes often develops more quickly and can cause symptoms like weight loss or a condition called diabetic ketoacidosis. Diabetic ketoacidosis can occur when you have very high blood sugars, but little or no insulin in your body.

Symptoms of both types of diabetes can appear at any age, but generally type 1 occurs in children and young adults. Type 2 occurs in people over the age of 45. But younger people are increasingly being diagnosed with type 2 diabetes due to sedentary lifestyles and an increase in weight.

How common is diabetes?

About 30.3 millionTrusted Source people in the United States have diabetes. About 5 to 10 percent have type 1 diabetes, while 90 to 95 percent have type 2 diabetes.

The latest figures show that 1.5 million adults were newly diagnosed in 2015. Another 84.1 million are thought to have prediabetes. But most people with prediabetes don’t know they have the condition.

Prediabetes occurs when your blood glucose is higher than it should be, but not high enough to be diabetes.

You’re more likely to develop diabetes if you have a family history of the disease.

Other risk factors for type 2 diabetes include:

  • having a sedentary lifestyle
  • being overweight
  • having had gestational diabetes or prediabetes

What are the potential complications?

Complications of diabetes generally develop over time. Having poorly controlled blood sugar levels increases the risk of serious complications that can become life-threatening. Chronic complications include:

  • vessel disease, leading to heart attack or stroke
  • eye problems, called retinopathy
  • infection or skin conditions
  • nerve damage, or neuropathy
  • kidney damage, or nephropathy
  • amputations due to neuropathy or vessel disease

Type 2 diabetes may increase the risk of developing Alzheimer’s disease, especially if your blood sugar is not well controlled.

Complications in pregnancy

High blood sugar levels during pregnancy can harm mother and child, increasing the risk of:

  • high blood pressure
  • preeclampsia
  • miscarriage or stillbirth
  • birth defects

How are different types of diabetes treated?

No matter what type of diabetes you have, you’ll need to work closely with your doctor to keep it under control.

The main goal is to keep blood glucose levels within your target range. Your doctor will let you know what your target range should be. Targets vary with the type of diabetes, age, and presence of complications.

If you have gestational diabetes, your blood sugar targets will be lower than people with other types of diabetes.

Physical activity is an important part of diabetes management. Ask your doctor how many minutes per week you should devote to aerobic exercise. Diet is also crucial to good control. You’ll also need to monitor your blood pressure and cholesterol.

Treating type 1

All people with type 1 diabetes must take insulin to live because damage to the pancreas is permanent. There are different types of insulin available with different times of onset, peak, and duration.

Insulin is injected just under the skin. Your doctor will show you how to properly inject and rotate injection sites. You can also use an insulin pump, which is a device worn outside your body that can be programmed to release a specific dose. There are now continuous blood glucose monitors as well that check your sugar 24 hours a day.

You’ll need to monitor your blood sugar levels throughout the day. If necessary, you may also need to take medication to control cholesterol, high blood pressure, or other complications.

Treating type 2

Type 2 diabetes is managed with diet and exercise, and can also be treated with a variety of medications to help control blood sugar. The first-line medication is usually metformin (Glumetza, Glucophage, Fortamet, Riomet). This drug helps your body use insulin more effectively. If metformin doesn’t work, your doctor can add other medications or try something different.

You’ll need to monitor your blood sugar levels. You may also need medications to help control blood pressure and cholesterol.

Prevention

There’s no known prevention for type 1 diabetes.

You can lower your risk of type 2 diabetes if you:

  • control your weight and manage your diet
  • exercise regularly
  • avoid smoking, high triglycerides, and low HDL cholesterol levels

If you had gestational diabetes or have prediabetes, these habits can delay or prevent the onset of type 2 diabetes.

How insulin problems develop

Doctors do not know the exact causes of type 1 diabetes. However, insulin resistance, which can lead to type 2 diabetes, has clearer causes.

Insulin allows the glucose from a person’s food to access the cells in their body to supply energy. Insulin resistance is usually a result of the followingTrusted Source cycle:

1.   A person has genes or an environment that make it more likely for them to be unable to produce enough insulin to cover how much glucose, or sugar, they eat.

2.   The body tries to make extra insulin to process the excess blood sugar.

3.   The pancreas cannot keep up with the increased demands, and the excess blood sugar starts to circulate in the blood, causing damage.

4.   Over time, insulin becomes less effective at introducing glucose to cells, and blood sugar levels continue to rise.

With type 2 diabetes, insulin resistance takes place gradually. This is why doctors often recommend making lifestyle changes in an attempt to slow or reverse this cycle.

Exercise and diet tips

If a doctor diagnoses somone with diabetes, they will oftenTrusted Source recommend making lifestyle changes to support weight management and overall health.

A doctor may refer a person living with diabetes or prediabetes to a nutritionist. A specialist can help people living with diabetes lead an active, balanced lifestyle and manage the condition.

Steps a person can take to stay healthy with diabetes include:

  • Eating a diet high in fresh, nutritious foods, including whole grains, fruits, vegetables, lean proteins, low-fat dairy, and healthy fat sources, such as nuts.
  • Avoiding high-sugar foods that provide empty calories or calories that do not have other nutritional benefits, such as sweetened sodas, fried foods, and high-sugar desserts.
  • Refraining from drinking excessive amounts of alcohol or keeping intake to less than one drink a day for females or two drinks a day for males.
  • Engaging in at least 30 minutes of exercise per day on at least 5 days of the week, such as walking, aerobics, riding a bike, or swimming.
  • Recognizing signs of low blood sugar when exercising, including dizziness, confusion, weakness, and profuse sweating.

Some people can also take steps to reduce their body mass index (BMI) if needed, which can help those with type 2 diabetes manage the condition without medication.

Using insulin

All people living with type 1 diabetes and some people living with type 2 diabetes need to administer insulin to keep their blood sugar levels from becoming too high.

Various types of insulin are available, and most are grouped by how long their effect lasts. There are rapid-acting, short-acting, intermediate-acting, long-acting, and mixed insulins.

Some people will use long-acting insulin to maintain consistently low blood sugar levels. Others may use short-acting insulin or a combination of insulin types. Whatever the type, a person will usually check their blood sugar levels to determine how much insulin they need.

To check blood sugar levels, a person can use a blood glucose monitor, which involves pricking their skin, or a combination of a continuous blood glucose monitor (CGM) and skin pricks.

A CGM takes blood sugar readings regularly throughout the day. They can help a person make any adjustments to their medications.

Self-monitoring is the only way a person can find out their blood sugar levels. Assuming the level from any physical symptoms that occur may be dangerous unless a person suspects extremely low sugar and thinks they need a rapid dose of glucose.

How much is too much?

Insulin helps people living with diabetes live an active lifestyle. However, it can lead to serious side effects, especially if a person administers too much.

Excessive insulin can cause hypoglycemia, or extremely low blood sugar, and lead to nausea, sweating, and shaking.

It is essential that people measure insulin carefully, adjust their medications based on their needs, and eat a consistent diet that helps to balance blood sugar levels as much as possible.

Other medications

In addition to insulin, other types of medication are available that can help people manage their condition.

Metformin

A doctor may prescribe metformin in pill form to a person with type 2 diabetes.

It contributes to:

  • lowering blood sugar
  • making insulin more effective

People living with diabetes may also have other health risks, which they may also need medication to control. A doctor will advise the individual about their needs.

SGLT2 inhibitors and GLP-1 receptor agonists

In 2018, new guidelines also recommended prescribing additional drugs for people with:

  • atherosclerotic cardiovascular disease
  • chronic kidney disease

These are sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide-1 (GLP-1) receptor agonists.

For those with atherosclerotic cardiovascular disease and a high risk of heart failure, the guidelines advise doctors to prescribe an SGLT2 inhibitor.

GLP-1 receptor agonists work by increasing the amount of insulin the body produces and decreasing the amount of glucose that enters the bloodstream. It is an injectable medication. People may use it with metformin or alone. Side effects include gastrointestinal problems, such as nausea and a loss of appetite.

SLGT2 inhibitors are a new typeTrusted Source of drug for lowering blood sugar levels. They work separately from insulin, and may be useful for people who are not ready to start using insulin. People can take it by mouth. Side effects include a higher risk of urinary and genital infections and ketoacidosis.

Self-monitoring tips

Self-monitoring blood sugar levels is vital for effective diabetes managementTrusted Source, helping to regulate meal scheduling, physical activity, and when to take medication, including insulin.

While self-monitoring blood glucose machines vary, they will generally include a meter and test strip for generating readings. It will also involve using a lancing device to prick the skin for obtaining a small quantity of blood.

Precautions

People should refer to the specific instructions of a meter in every case, as machines will differ. However, the following precautions and steps will apply to many devices on the market:

  • Making sure both hands are clean and dry before touching the test strips or meter.
  • Using a test strip once only and keeping them in their original canister to avoid any external moisture changing the result.
  • Keeping canisters closed after testing.
  • Checking the expiration date before use.
  • Checking whether the machine requires coding before use, which may apply to older varieties
  • Storing the meter and strips in a dry, cool area.
  • Taking the meter and strips to consultations so that a primary care physician or specialist can check their effectiveness.

Tips

People checking their blood sugar levels with a blood glucose meter will also use a device called a lancet to prick their finger. While the idea of drawing blood might cause distress for some people, lancing the skin to obtain a blood sample should be a gentle, simple procedure. Many meters require only a teardrop-sized sample of blood.

A person may also find the following tips useful:

  • Using their fingertips to obtain a blood sample. While some meters allow samples from other test sites, such as the thighs and upper arms, the fingertips or outer palms produce more accurate results.
  • Cleaning their skin with soapy, warm water to avoid food residue entering the device and distorting the reading.
  • Choosing a small, thin lancet for maximum comfort.
  • Adjusting the lancet’s depth settings for comfort.
  • Taking blood from the side of their finger, as this causes less pain. Using the middle finger, ring finger, and little finger may be more comfortable.
  • Teasing blood to the surface in a “milking” motion rather than placing pressure at the lancing site.
  • Following local regulations for disposing of sharp objects, including lancets.

While remembering to self-monitor involves people making lifestyle adjustments, it need not be an uncomfortable process.

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