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Diabetes is a condition where people don't produce
enough insulin to meet their body's needs and/or their cells don't
respond properly to insulin. Insulin is important because it moves
glucose, a simple sugar, into the body's cells from the blood. It also
has a number of other effects on metabolism.
The food that people eat provides the body with glucose, which is used
by the cells as a source of energy. If insulin isn't available or
doesn't work correctly to move glucose from the blood into cells,
glucose will stay in the blood. High blood glucose levels are toxic, and
cells that don't get glucose are lacking the fuel they need.
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There are two main kinds of diabetes: type 1 diabetes and type 2
diabetes. More than 90% of all people with diabetes have type 2.
Overall, about 30 million people in North America have diabetes. Only
about two-thirds of people with type 2 diabetes are aware of it and are
receiving treatment because, for many people, early symptoms are not
noticeable without testing.
Type 1 diabetes occurs when the pancreas cannot make insulin. Everyone
with type 1 diabetes requires insulin injections.
Type 2 diabetes occurs when the pancreas does not make enough insulin or
the body does not use insulin properly. It usually occurs in adults,
although in some cases children may be affected. People with type 2
diabetes usually have a family history of this condition and are most
often overweight. People with type 2 diabetes may eventually need
insulin injections. This condition occurs most commonly in people of
First Nations descent, Hispanics, and North Americans of African
descent.
Another less common form is gestational diabetes, a temporary condition
that occurs during pregnancy. According to the Canadian Diabetes
Association (CDA), about 4% of women, and up to 18% of First Nations
women, will develop gestational diabetes. The problem usually clears up
after delivery, but women who have had gestational diabetes have a
higher risk of developing type 2 diabetes later in life.
Causes of Diabetes
Type 1 diabetes is an autoimmune disorder. It's believed that a
combination of genetic predisposition and additional (as yet
unidentified) factors provoke the immune system into attacking and
killing the insulin-producing cells in the pancreas.
Type 2 diabetes is mainly caused by insulin resistance. This means no
matter how much or how little insulin is made, the body can't use it as
well as it should. As a result, glucose can't be moved from the blood
into cells. Over time, the excess sugar in the blood gradually poisons
the pancreas causing it to make less insulin and making it even more
difficult to keep blood glucose under control.
Obesity is a leading cause of insulin resistance – at least 80% of
people with type 2 diabetes are overweight. Genetic factors are also
likely to be involved in the cause of type 2 diabetes. A family history
of the disease has been shown to increase the chances of getting it.
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Other risk factors for the development of type 2
diabetes include:
acanthosis nigricans
being 40 years of age or older
blood vessel disease (e.g., damage to blood vessels in the eyes, nerves,
kidneys, heart, brain, or arms and legs)
First Nation, Hispanic, South Asian, Asian, or African descent
giving birth to a large baby
high blood pressure
high cholesterol
a history of gestational diabetes
HIV infection
mental health disorders (e.g., bipolar disorder, depression,
schizophrenia)
obstructive sleep apnea
polycystic ovary syndrome
prediabetes or impaired fasting glucose
use of certain medications (e.g., corticosteroids such as prednisone,
certain antipsychotic medications, certain antiviral medications for
HIV)
Symptoms and Complications of Diabetes
People with type 1 diabetes who are not being treated urinate frequently
and feel excessively thirsty. They usually feel very tired and
experience severe weight loss despite normal or excessive food intake.
The symptoms of type 2 diabetes usually appear more gradually. People
with type 2 diabetes who do not have their blood glucose under control
often have a persistent, mild thirst. They urinate frequently, and often
feel mild fatigue and complain of blurred vision. Many women with the
disease have recurring vaginal yeast infections.
Diabetes is a major cause of heart disease, one of the leading causes of
death in Canada. It's also the biggest cause of blindness and kidney
failure in adults. Older adults with diabetes are twice as likely to
develop high blood pressure as people without diabetes.
People with diabetes are also much more likely to undergo foot and other
"lower extremity" amputations due to circulatory problems. Between
one-third and one-half of men who have diabetes will experience erectile
dysfunction at some point.
Diagnosing Diabetes
Diabetes is diagnosed with simple blood tests. Your doctor may diagnose
diabetes if the level of glucose in your blood after 8 hours of fasting
is 7.0 mmol/L or higher. If your fasting blood glucose is between 6.1
mmol/L and 6.9 mmol/L, then you may have a condition known as impaired
fasting glucose or prediabetes, which may later develop into diabetes.
Your doctor may also diagnose diabetes using a blood test called A1C
(also called glycated hemoglobin), which reflects the average blood
glucose levels over the past 2 to 3 months. Your doctor may diagnose
diabetes if the A1C level is 6.5% or greater. If your A1C is between
6.0% and 6.4%, you may have prediabetes. A1C is not used to diagnose
diabetes for children, adolescents, pregnant women, or people with
suspected type 1 diabetes.
Diabetes can also be diagnosed with a random blood glucose level. This
is a blood glucose level taken any time of the day without regard to
meals. If this level is 11.1 mmol/L or higher, your doctor may diagnose
diabetes.
Doctors may also diagnose diabetes based on the results of an oral
glucose tolerance test (OGTT). With this test, a person fasts and then
is given a drink containing 75 g of carbohydrate. The blood sugar is
checked at fasting and 2 hours after drinking the solution. Your doctor
may diagnose diabetes if your blood sugar is greater than 11.1 mmol/L
after 2 hours.
It is important to note that one high blood glucose reading or A1C does
not necessarily mean you have diabetes. Unless you are having symptoms
of diabetes, at least 2 high blood glucose or A1C readings are required
before your doctor will make a diagnosis.
Treating and Preventing Diabetes
Currently, type 1 diabetes is not preventable. However, studies have
shown that type 2 diabetes can be prevented by adopting lifestyle
changes that include eating a healthy diet and exercising.
In addition, some studies have shown that certain oral antidiabetes
medications may play a role in preventing the development of type 2
diabetes for people who are at high risk of developing it. Lifestyle
changes and medications may prevent approximately 30% to 60% of type 2
diabetes.
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Diabetes is a chronic condition, and it can last an entire life. The
goal of treating diabetes is to keep blood glucose levels as close to a
normal range as possible. This prevents the symptoms of diabetes and the
long-term complications of the condition. If you've been diagnosed with
diabetes, your doctor – working with the members of your diabetes care
team – will help you find your target blood glucose levels.
More than most conditions, treating diabetes requires a significant
amount of real effort on the person's part. Coping with diabetes is a
lifelong challenge, so people with diabetes should not be afraid to
speak with a doctor or pharmacist if they feel overwhelmed.
Part of a treatment plan for diabetes will involve learning about
diabetes, how to manage it, and how to prevent complications. Your
doctor, diabetes educator, or other health care professional will help
you learn what you need to know so you are able to manage your diabetes
as effectively as possible. Keep in mind that learning about diabetes
and its treatment will take time. Involving family members or other
people who are significant in your life can also help you manage your
diabetes.
Although up to 30% of people with diabetes use herbal products to help
control blood sugar, there are not enough good quality studies to show
that these treatments are safe and effective.
People with type 1 diabetes need insulin* continuously to survive.
There are three important things a person can do to treat type 2
diabetes:
make lifestyle changes such as diet and exercise
use medication
monitor blood glucose levels
As with many conditions, treatment of type 2 diabetes begins with
lifestyle changes, particularly in your diet and exercise. If you have
type 2 diabetes, speak to your doctor and diabetes educator about an
appropriate diet. You may be referred to a dietitian. It is also a good
idea to speak with your doctor before beginning an exercise program to
determine how much and what kind of exercise is appropriate.
If lifestyle changes don't put blood glucose levels in the target range,
medications may be required. Medications for type 2 diabetes include
antidiabetes pills, insulin injections, or a combination of both.
Medications are very effective at treating diabetes and reducing the
symptoms and long-term effects of the condition. However, you may
experience hypoglycemia (a blood glucose level that is too low) when
taking certain medications for diabetes.
Symptoms of hypoglycemia include:
anxiety
confusion
difficulty concentrating
dizziness
drowsiness
fatigue
headache
hunger
irritability
pale skin
sweating
tremors or shakiness
visual changes
If your blood glucose level is extremely low, it is possible to have a
seizure or lose consciousness. A health care professional can teach you
how to recognize the warning signs of hypoglycemia. People with diabetes
should carry candy, sugar, or glucose tablets to treat hypoglycemia.
Hypoglycemia is a side effect of many medications for type 1 and 2
diabetes, but it is never a reason to avoid treatment. The best way to
avoid hypoglycemia is to monitor your blood glucose.
Measurement of blood glucose levels is the best way to know whether
blood glucose levels are in the target range. This is easily done at
home with a blood glucose monitor.
In recent guidelines, the CDA says it's important for people with
diabetes to self-monitor blood glucose levels. The number of times you
should test your blood glucose will be based on the type of diabetes you
have and your diabetes treatment.
It is important to record blood glucose readings taken at different
times of the day – after fasting as well as 2 hours after a meal. This
allows your doctor to see a snapshot of how your blood glucose levels
vary during the day and to recommend treatments accordingly. Most blood
glucose meters now have "memory" that stores a number of blood glucose
tests along with the time and date they were taken. Some even allow for
graphs and charts of the results to be created when the monitor is
connected to a computer.
Your doctor can also follow your A1C results to see how well your blood
glucose has been in control overall. This allows your doctor to manage
your diabetes more effectively. A1C is usually measured every 3 to 6
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