Diabetes is a disease that affects your body’s ability to produce or use insulin. Insulin is a hormone. When your body turns the food you eat into energy (also called sugar or glucose), insulin is released to help transport this energy to the cells. Insulin acts as a “key.” Its chemical message tells the cell to open and receive glucose. If you produce little or no insulin, or are insulin resistant, too much sugar remains in your blood. Blood glucose levels are higher than normal for individuals with diabetes. There are two main types of diabetes: Type 1 and Type 2.
When you are affected with Type 1 diabetes, your pancreas does not produce insulin. Type 1 diabetes is also called juvenile diabetes, since it is often diagnosed in children or teens. This type accounts for 5-10 percent of people with diabetes.
Type 2 diabetes occurs when the body does not produce enough insulin, or when the cells are unable to use insulin properly, which is called insulin resistance. Type 2 diabetes is commonly called “adult-onset diabetes” since it is diagnosed later in life, generally after the age of 45. 90-95 percent of people with diabetes have this type. In recent years Type 2 diabetes has been diagnosed in younger people, including children, more frequently than in the past.
Gestational diabetes usually goes away after pregnancy, but once you’ve had gestational diabetes, your chances are higher that it will happen in future pregnancies. In some women pregnancy uncovers Type 1 or Type 2 diabetes and these women will need to continue diabetes treatment after pregnancy.
There seems to be a link between the tendency to have gestational diabetes and Type 2 diabetes, and many women who had gestational diabetes develop Type 2 diabetes later on. Gestational diabetes and Type 2 diabetes both involve insulin resistance. Certain basic lifestyle changes may help prevent diabetes after gestational diabetes.
Pre-diabetes is a condition that causes a person’s blood sugar levels to be higher than normal but not high enough to be diagnosed with diabetes.
Type 1 diabetes is caused by a lack of insulin due to the destruction of insulin-producing beta cells in the pancreas. In type 1 diabetes—an autoimmune disease—the body’s immune system attacks and destroys the beta cells. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. But in autoimmune diseases, the immune system attacks the body’s own cells. In type 1 diabetes, beta cell destruction may take place over several years, but symptoms of the disease usually develop over a short period of time.
Type 1 diabetes typically occurs in children and young adults, though it can appear at any age. In the past, type 1 diabetes was called juvenile diabetes or insulin-dependent diabetes mellitus.
Latent autoimmune diabetes in adults (LADA) may be a slowly developing kind of type 1 diabetes. Diagnosis usually occurs after age 30. In LADA, as in type 1 diabetes, the body’s immune system destroys the beta cells. At the time of diagnosis, people with LADA may still produce their own insulin, but eventually most will need insulin shots or an insulin pump to control blood glucose levels.
Type 2 diabetes—the most common form of diabetes—is caused by a combination of factors, including insulin resistance, a condition in which the body’s muscle, fat, and liver cells do not use insulin effectively. Type 2 diabetes develops when the body can no longer produce enough insulin to compensate for the impaired ability to use insulin. Symptoms of type 2 diabetes may develop gradually and can be subtle; some people with type 2 diabetes remain undiagnosed for years.
Type 2 diabetes develops most often in middle-aged and older people who are also overweight or obese. The disease, once rare in youth, is becoming more common in overweight and obese children and adolescents. Scientists think genetic susceptibility and environmental factors are the most likely triggers of type 2 diabetes.
Pathophysiology of type 1 diabetes
In this condition the immune system attacks and destroys the insulin producing beta cells of the pancreas. There is beta cell deficiency leading to complete insulin deficiency. Thus is it termed an autoimmune disease where there are anti insulin or anti-islet cell antibodies present in blood. These cause lymphocytic infiltration and destruction of the pancreas islets. The destruction may take time but the onset of the disease is rapid and may occur over a few days to weeks.
There may be other autoimmune conditions associated with type 1 diabetes including vitiligo and hypothyroidism. Type 1 diabetes always requires insulin therapy, and will not respond to insulin-stimulating oral drugs.
Pathophysiology of type 2 diabetes
This condition is caused by a relative deficiency of insulin and not an absolute deficiency. This means that the body is unable to produce adequate insulin to meet the needs. There is Beta cell deficiency coupled with peripheral insulin resistance.
Peripheral insulin resistance means that although blood levels of insulin are high there is no hypoglycaemia or low blood sugar. This may be due to changes in the insulin receptors that bring about the actions of the insulin.
Obesity is the main cause of insulin resistance. In most cases over time the patients need to take insulin when oral drugs fail to stimulate adequate insulin release.
Hunger and fatigue. Your body converts the food you eat into glucose that your cells use for energy. But your cells need insulin to bring the glucose in.
If your body doesn’t make enough or any insulin, or if your cells resist the insulin your body makes, the glucose can’t get into them and you have no energy. This can make you more hungry and tired than usual.
Peeing more often and being thirstier. The average person usually has to pee between four and seven times in 24 hours, but people with diabetes may go a lot more.
Dry mouth and itchy skin. Because your body is using fluids to make pee, there’s less moisture for other things. You could get dehydrated, and your mouth may feel dry. Dry skin can make you itchy.
Blurred vision. Changing fluid levels in your body could make the lenses in your eyes swell up. They change shape and lose their ability to focus.
Diabetes may be diagnosed based on A1C criteria or plasma glucose criteria, either the fasting plasma glucose (FPG) or the 2-h plasma glucose (2-h PG) value after a 75-g oral glucose tolerance test (OGTT).
The same tests are used to both screen for and diagnose diabetes. Diabetes may be identified anywhere along the spectrum of clinical scenarios: in seemingly low-risk individuals who happen to have glucose testing, in symptomatic patients, and in higher-risk individuals whom the provider tests because of a suspicion of diabetes. The same tests will also detect individuals with prediabetes.
- Controlling blood sugar (glucose) levels is the major goal of diabetes treatment, in order to prevent complications of the disease.
- Type 1 diabetes is managed with insulin as well as dietary changes and exercise.
- Type 2 diabetes may be managed with non-insulin medications, insulin, weight reduction, or dietary changes.