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What is Diabetes?

Brent Pritt

Diabetes (also known as diabetes mellitus) is a commonly known, but less commonly understood, chronic disease that affects roughly 9.3% of the world population as of 2019. (1) In real world numbers this means just under half a billion people suffer from this disease worldwide. Unfortunately, when something is so common, it begins to lose its serious nature in the eyes of the general public. In fact, over 1 million deaths per year can be traced back to diabetes alone ranking it the ninth leading cause of death globally. (2)

In this series of three articles I want to bring some healthy respect and awareness back to this prevalent chronic disease. We will discuss what diabetes is within this first article. The second in the series will discuss the complications and long term damage that can occur with diabetes. The third in the series will investigate possible treatment and the management of diabetes. Let’s dive in shall we!

So What is Diabetes?

The World Health Organization (WHO) defines diabetes as, “a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.” (3) Insulin is a key hormone involved in maintaining healthy blood sugar levels after meals. It helps muscle, fat, and liver cells absorb glucose from the blood and store for later use when excess blood glucose is present. (4) In turn insulin helps regulate your energy levels throughout the day, and when working appropriately, keep your energy levels on an even keel without any crashes or spikes. When this process is disrupted, a host of secondary issues occur culminating in what we know as diabetes.

The Four Types of Diabetes

Although diabetes is widely recognized in the general public, it is rarely thought of as an umbrella term for a subset of four types of pathology. These four types of diabetes include:

  • Type 1 Diabetes

  • Type 2 Diabetes

  • Prediabetes

  • Gestational Diabetes

Type 1 Diabetes

Type 1 diabetes is also referred to as insulin-dependent or juvenile diabetes. It accounts for approximately 5-10% of all cases of diabetes worldwide. (5) This form of diabetes is characterized by the body’s inability to produce insulin on its own. An inability to produce insulin is thought to occur secondary to an autoimmune response which leads a person’s own immune system to attack their pancreas. When the immune system attacks the pancreas it ends up killing off portions called beta cells. These beta cells are the manufactures of insulin, and thus when destroyed, production of insulin stops.

Risk Factors for Type 1 Diabetes

The risk factors for type 1 diabetes are not completely clear at this time. (6) The biggest risk factor known currently is a familial history of the disease, especially in the context of your immediate family (parents or siblings). The disease may occur at any age but more often onsets in childhood or young adulthood.

Symptoms of Type 1 Diabetes

Once insulin production stops, blood sugar begins to rise to dangerous levels and the symptoms of type 1 diabetes manifest.(5) Symptoms may take anywhere from weeks to years to become noticeable. Once present, these symptoms can be severe and life changing.

Symptoms of type 1 diabetes can be both mild or severe. Symptoms include (7):

  • Nausea

  • Vomiting

  • Stomach pains

  • Frequent urination (especially in the night)

  • Extreme thirst or hunger

  • Unexplained weight loss

  • Altered vision

  • Altered sensation in hands or feet (neuropathy)

  • Extreme fatigue

  • Abnormally dry skin

  • Impaired healing ability

  • Decreased immune responses

Type 2 Diabetes

Type 2 diabetes is much more prevalent than type 1 diabetes and is estimated to affect 462 million people worldwide or over 6% of the world population. (2) 90-95% of the individuals you encounter with diabetes will have this form. (8)

Although type 1 diabetes stems from an inadequate production of insulin, type 2 diabetes originates due to something called insulin resistance. Insulin resistance is defined as “a subnormal biological response to normal insulin concentrations”. (9) In plain English this means that cells of the muscles, fat, and liver do not respond to insulin even when insulin is at normal healthy levels. Essentially these cells ignore insulin and refuse to take in glucose from the blood.

Once insulin resistance sets in, the body attempts to find a new balance and the pancreas ramps up the production of insulin in an attempt to get the cells’ attention. (8) Unfortunately this strategy only works so long before the pancreas no longer is able to keep up. At this stage blood sugar levels rise dramatically and the initial symptoms of type 2 diabetes may set in.

Risk Factors for Type 2 Diabetes

Risk factors for type 2 diabetes are much clearer than for type 1 diabetes. They usually onset over a long period such as several years. Such a long period of onset can sometimes make symptoms hard to spot at first. Risk factors include (10, 11):

  • Having prediabetes

  • Being overweight

  • 45 years old +

  • Have a family member with type 2 diabetes

  • Perform physical activity less than 3 times per week

  • Have a history of gestational diabetes or given birth to a baby weighing over 9 pounds

  • Are of African American, Hispanic or Latino, American Indian, or Alaskan Native descent

  • Have non-alcoholic fatty liver disease

  • Having Polycystic Ovary Syndrome (PCOS)

  • Have consistent trouble sleeping

Symptoms of Type 2 Diabetes

Symptoms of type 2 diabetes are extremely similar to type 1 diabetes despite their different mechanisms of onset. This is because in either case blood sugar levels rise to dangerous levels and lead to a similar cascade of events. These symptoms include (7):

  • Frequent urination (especially in the night)

  • Extreme thirst or hunger

  • Unexplained weight loss

  • Altered vision

  • Altered sensation in hands or feet (neuropathy)

  • Extreme fatigue

  • Abnormally dry skin

  • Impaired healing ability

  • Decreased immune responses

Prediabetes

Prediabetes is a state in which blood sugar levels are much higher than normal, but not to the levels of being diagnosed with type 2 diabetes. (12) Although prediabetes has varying diagnostic criteria across the world, in the United States it is estimated that roughly 96 million American adults have this condition. (13, 14) Unfortunately, approximately 80% of these individuals are unaware of having prediabetes.

Prediabetes occurs via the same mechanisms as type 2 diabetes but at an earlier point in time of the disease process. This condition increases the likelihood of being diagnosed with type 2 diabetes later in life, having heart disease, as well as suffering from a stroke. (12)

Risk Factors for Prediabetes

Due to prediabetes just being an earlier stage of type 2 diabetes, the risk factors are all mostly the same. These risk factors include (10, 11):

  • Being overweight

  • 45 years old +

  • Have a family member with type 2 diabetes

  • Perform physical activity less than 3 times per week

  • Have a history of gestational diabetes or given birth to a baby weighing over 9 pounds

  • Are of African American, Hispanic or Latino, American Indian, or Alaskan Native descent

  • Have non-alcoholic fatty liver disease

  • Having Polycystic Ovary Syndrome (PCOS)

  • Have consistent trouble sleeping

Symptoms of Prediabetes

No clear symptoms of prediabetes are present in most people. (15) Testing is required to determine if someone has prediabetes. Some of these individuals may show darkened skin in the areas of the armpits, back, and sides of their neck. Additionally, excess skin may grow in these areas.

Gestational Diabetes

Due to hormonal changes in the body, an expectant mother may become insulin resistant just like in type 2 diabetes. (16) This often occurs after the 24th week of pregnancy. Some amount of insulin resistance is normal for all pregnant women but gestational diabetes takes this a step further. This form of diabetes only occurs in pregnant women, and may develop in those who do not have a history of diabetes at all.

Most women will return to normal levels of blood sugar after birth, but approximately half of women who had gestational diabetes will go on to develop type 2 diabetes at a later date.

Risk Factors for Gestational Diabetes

Risk factors for gestational diabetes are similar to those for type 2 diabetes. These include (17):

  • Being overweight

  • Being over 25 years old at time of pregnancy

  • Have a family member with type 2 diabetes

  • Have a history of gestational diabetes or given birth to a baby weighing over 9 pounds

  • Are of African American, Hispanic or Latino, American Indian, or Alaskan Native descent

  • Have prediabetes

Symptoms of Gestational Diabetes

Usually, gestational diabetes will not cause any noticeable symptoms. (18) Increased thirst and frequent urination may occur but these may also be signs of a normal pregnancy as well.

Testing for Diabetes

Testing for diabetes is fairly simple and can determine which kind you may have. These tests include (19):

  • A1C Test

  • Fasting Blood Sugar Test

  • Glucose Tolerance Test

  • Random Blood Sugar Test

A1C Test

This test measures average blood sugar levels for the last 3 months. It is also called the hemoglobin A1C test or the HbA1c test.

Hemoglobin is a protein that is found within your red blood cells and may have glucose attached to it. (20) When glucose attaches to the hemoglobin it has become what is called glycosylated. This glucose stays attached to the red blood cell for the life of the cell. The average lifespan of a red blood cell is 2-3 months.

The essentially permanent bond of the glucose to hemoglobin over a roughly 3 month time span is why the A1C test measures blood sugar levels for the last 3 months. Although glucose attached to hemoglobin is normal, high levels are not. Higher levels can indicate diabetes of one form or another. (21)

No special preparation is needed for an A1C test. (21) It is given via a finger prick blood sampling.

A1C Test Results (21)

  • Normal: Below 5.7%

  • Prediabetes: 5.7% - 6.4%

  • Diabetes 6.5% or above

Fasting Blood Sugar Test

Fasting blood sugar tests are quite simple. Blood is taken for testing after the patient fasts (does not eat food) for 8-12 hours. (22) Often the blood is drawn via a finger prick test which is fairly pain-free and non-invasive, but in some circumstances the blood may be drawn via traditional means and put into a test-tube.

If a finger prick test is performed, your doctor may be able to determine your blood sugar levels in the office using a glucose monitor and testing strips. If a vial of blood is drawn, your doctor will most likely be sending the sample to a lab for final testing.

Fasting Blood Sugar Test Results (19)

  • Normal: 99 mg/dl or below

  • Prediabetes: 100-125 mg/dl

  • Diabetes: 126 mg/dl or above

Glucose Tolerance Test

This test entails the patient ingesting a glucose containing solution, after an overnight fast, and seeing how the body responds to the drink. (19) The patient has their blood sugar checked at varying intervals including pre-drink (fasting blood sugar test), 1 hour post-drink, 2 hours post-drink, and potentially 3 hours post-drink.

Glucose Tolerance Test Results (19)

Normal: 140 mg/dl or below

Prediabetes: 140-199 mg/dl

Diabetes: 200 mg/dl or above

Random Blood Sugar Test

A random blood sugar test is exactly what it sounds like. In this test a blood sample is taken at a random time of day with no restrictions or parameters regarding what has been eaten prior to the test. (23) The blood sample is then tested for its blood sugar content.

Random Blood Sugar Test Results (19)

Normal: Not defined

Prediabetes: Not defined

Diabetes: 200mg/dl or above

Final Thoughts

So as we have learned, diabetes is a general umbrella term. Although some people are born with the genetic predisposition for type 1 diabetes, others lead themselves to the disease through lifestyle choices. In some cases the onset of the disease can take quite sometime and sneak up on an unsuspecting victim. Fortunately, testing for this pathology is fairly simple through a series of blood tests. The next article in this series will dive a bit more into the complications that may arise with prolonged diabetes and how this factors into balance and fall risk.

Thanks for reading!

References

1) Saeedi P, Petersohn I, Salpea P et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843. doi:10.1016/j.diabres.2019.107843

2) Khan M, Hashim M, King J, Govender R, Mustafa H, Al Kaabi J. Epidemiology of Type 2 Diabetes – Global Burden of Disease and Forecasted Trends. J Epidemiol Glob Health. 2019;10(1):107. doi:10.2991/jegh.k.191028.001

3) Diabetes. Who.int. https://www.who.int/news-room/fact-sheets/detail/diabetes. Published 2022. Accessed June 26, 2022.

4) Pancreas Hormones. Endocrine.org. https://www.endocrine.org/patient-engagement/endocrine-library/hormones-and-endocrine-function/pancreas-hormones#:~:text=Essential%20for%20life%2C%20the%20hormone,the%20pancreas%2C%20which%20produces%20insulin. Published 2022. Accessed June 26, 2022.

5) What is Type 1 Diabetes?. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/what-is-type-1-diabetes.html. Published 2022. Accessed June 26, 2022.

6) Diabetes Risk Factors. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/risk-factors.html. Published 2022. Accessed June 26, 2022.

7) Diabetes Symptoms. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/symptoms.html. Published 2022. Accessed June 26, 2022.

8) Type 2 Diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/type2.html. Published 2022. Accessed June 26, 2022.

9) UpToDate. Uptodate.com. https://www.uptodate.com/contents/insulin-resistance-definition-and-clinical-spectrum. Published 2022. Accessed June 26, 2022.

10) Diabetes Risk Factors. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/risk-factors.html. Published 2022. Accessed June 26, 2022.

11) Prediabetes - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/prediabetes/symptoms-causes/syc-20355278. Published 2022. Accessed June 26, 2022.

12) Prediabetes – Your Chance to Prevent Type 2 Diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/prediabetes.html. Published 2022. Accessed June 26, 2022.

13) Bansal N. Prediabetes diagnosis and treatment: A review. World J Diabetes. 2015;6(2):296. doi:10.4239/wjd.v6.i2.296

14) Marker D, Mardon R, Jenkins F et al. State-level estimation of diabetes and prediabetes prevalence: Combining national and local survey data and clinical data. Stat Med. 2018;37(27):3975-3990. doi:10.1002/sim.7848

15) Topics H. Prediabetes | Hyperglycemia | MedlinePlus. Medlineplus.gov. https://medlineplus.gov/prediabetes.html. Published 2022. Accessed June 26, 2022.

16) Gestational Diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/gestational.html. Published 2022. Accessed June 26, 2022.

17) Gestational Diabetes Mellitus (GDM). Hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/diabetes/gestational-diabetes. Published 2022. Accessed June 26, 2022.

18) Gestational diabetes - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339. Published 2022. Accessed June 26, 2022.

19) Diabetes Tests. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/getting-tested.html. Published 2022. Accessed June 26, 2022.

20) Definition: Glycosylated Hemoglobin Test (Hemoglobin A1c) (for Parents) - Nemours KidsHealth. Kidshealth.org. https://kidshealth.org/en/parents/hba1c.html#:~:text=The%20glucose%20remains%20attached%20to,glycosylated%20hemoglobin%20in%20the%20blood. Published 2022. Accessed June 26, 2022.

21) All About Your A1C. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/managing/managing-blood-sugar/a1c.html. Published 2022. Accessed June 26, 2022.

22) Fasting Blood Sugar: Screening Test for Diabetes. Cleveland Clinic. https://my.clevelandclinic.org/health/diagnostics/21952-fasting-blood-sugar. Published 2022. Accessed June 26, 2022.

23) Diabetes - Diagnosis and treatment - Mayo Clinic. Mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/diabetes/diagnosis-treatment/drc-20371451#:~:text=Random%20blood%20sugar%20test.,)%20%E2%80%94%20or%20higher%20suggests%20diabetes. Published 2022. Accessed June 26, 2022.

Thank you for reading the article! I hope you learned a few new things about diabetes and found a new respect for this common disease. Be sure to leave a comment below if you have any questions or insight in regards to diabetes.

Happy falling!