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Diabetes is a disorder of metabolism—the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the main source of fuel for the body.



After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach.

When we eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.

The three main types of diabetes are

  • type 1 diabetes
  • type 2 diabetes
  • gestational diabetes

Type 1 Diabetes

Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body's system for fighting infection (the immune system) turns against a part of the body. In diabetes, the immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. A person who has type 1 diabetes must take insulin daily to live.

At present, scientists do not know exactly what causes the body's immune system to attack the beta cells, but they believe that autoimmune, genetic, and environmental factors, possibly viruses, are involved. It develops most often in children and young adults, but can appear at any age.

Symptoms of type 1 diabetes usually develop over a short period, although beta cell destruction can begin years earlier. Symptoms include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person with type 1 diabetes can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis.

Type 2 Diabetes

The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2. This form of diabetes is associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and ethnicity. About 80 percent of people with type 2 diabetes are overweight.

Type 2 diabetes is increasingly being diagnosed in children and adolescents. However, nationally representative data on prevalence of type 2 diabetes in youth are not available.

When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons, the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes—glucose builds up in the blood and the body cannot make efficient use of its main source of fuel.

The symptoms of type 2 diabetes develop gradually. Their onset is not as sudden as in type 1 diabetes. Symptoms may include fatigue or nausea, frequent urination, unusual thirst, weight loss, blurred vision, frequent infections, and slow healing of wounds or sores. Some people have no symptoms.

Gestational Diabetes

Gestational diabetes develops only during pregnancy. Like type 2 diabetes, it occurs more often among women with a family history of diabetes. Women who have had gestational diabetes have a 20 to 50 percent chance of developing type 2 diabetes within 5 to 10 years.

Risk Factors for Diabetes

Diabetes occurs in people of all ages and racial and ethnic groups. Researchers do not fully understand the cause of type 1 diabetes or what can be done to prevent it. Research suggests that type 1 diabetes has a strong genetic basis that is modified by environmental factors. Certain viruses are among the factors that have been suggested, but the definitive factors have yet to be determined. Having a family member with type 1 diabetes puts one at higher risk for developing the disease. However, most type 1 diabetes patients do not have a family history of the disease. Research is currently being done to learn more about the genetic and environmental factors important in type 1 diabetes.

Research conducted to date has identified specific risk factors related to the development of type 2 diabetes, pre-diabetes, and gestational diabetes, including family history, a sedentary lifestyle, and overweight or obesity. Maintaining a healthy weight as measured by body mass index (BMI) reduces one’s risk for developing type 2 diabetes, pre-diabetes, or gestational diabetes. BMI is a measure of weight in relation to height. Studies have shown that BMI is significantly correlated with body fat content for most adults. For adults, a BMI less than 25 is considered a healthy weight. Regular physical activity and eating a healthy diet can help attain and maintain a healthy weight.

Health Problems Related to Diabetes

Diabetes can have a significant impact on quality of life by increasing risk for a variety of complications. These include:

  • Blindness
  • Kidney Disease
  • High Blood Pressure
  • Heart Disease and Stroke
  • Nervous System Disease
  • Dental Disease
  • Amputations
  • Pregnancy Complications — Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5 percent to 10 percent of pregnancies and spontaneous abortions in 15 percent to 20 percent of pregnancies. 40 Poorly controlled diabetes during the second and third trimesters of pregnancy can result in very large babies, posing a risk to the mother and the child during delivery.
  • People with diabetes are more susceptible to many other illnesses and often have worse outcomes. For example, people with diabetes are more likely to die from pneumonia or the flu than people who do not have diabetes.

Action Steps for Prevention

  • Eat a variety of foods within the basic food groups (fruits, vegetables, grains, milk, and meat and beans).
  • Choose a diet low in fats (not recommended for children 2 years old and under), saturated fats, and cholesterol; and use sugar and alcohol in moderation
  • Order healthier food choices or split a meal with a friend or ask the server to put half of it in a take home box when dining out.
  • Use a salad plate for meals, rather than a full-size dinner plate, to make the meal appear larger.
  • Learn to use the food label to determine the size or amount of a portion or serving of foods and beverages. Consume appropriate portions of foods and beverages.
  • Drink a big glass of water or low-calorie beverage before a meal to help curb your hunger.
  • Drink plenty of water throughout the day.
  • Bake or broil foods rather than fry.
  • Drink 2 percent or 1 percent milk rather than whole milk.
  • Request a low-fat dressing for your salad.
  • Keep a daily record of eating habits, noting type of food, amount, and time of day. Determine times where overeating occurs and develop a plan to help avoid these situations in the future.
  • Find ways other than eating to deal with stress. Take a walk, stretch or take slow deep breaths.
  • Be “snackwise.” Have a piece of fruit or some reduced-fat popcorn instead of reaching for a piece of cake.
  • Make small nutritional changes. Some people find they are able to lose weight by simply eliminating sugary drinks.
  • Try some new recipes for healthier foods
  • Make regular physical activity an essential part of daily activities.
  • Exercise while watching TV by running or marching in place to avoid being a “couch potato.” Put away the remote and get up to change the channel on the TV.
  • Find an enjoyable exercise or physical activity and get active. For example, for those who enjoy dancing, put on some music and dance each day.
  • Take the stairs instead of elevators and escalators.
  • Park farther away from stores, or ride a bicycle or walk to stores.
  • Walk inside a mall as an inexpensive way to exercise in a sheltered space.
  • Volunteer to walk dogs at the local animal shelter or for an elderly neighbor.
  • Ask friends or use the Internet to find out about local parks or other facilities where you can exercise.

Set personal goals for exercise and track progress. For example, if a goal is to walk at least 30 minutes five times a week, keep a record of how many times the goal was met. If a day is missed, record it and indicate why it was missed. At the end of the week, consider what changes to make so that the goals for the following week will be met. Some people find it helpful to begin with smaller, easier-to-reach goals.

Early Diabetes Detection

Many people with type 2 diabetes have no signs or symptoms, but do have risk factors(see table below - "Signs and Symptoms of Diabetes"). For persons at increased risk or those experiencing these signs and symptoms, several tests are used to diagnose diabetes:

  • A fasting plasma glucose test measures blood glucose after not eating for at least 8 hours. This test is used to detect diabetes (126 mg/dl and above) or pre-diabetes (between 100 mg/dl and 125 mg/dl).
  • An oral glucose tolerance test measures blood glucose after not eating for at least 8 hours and 2 hours after drinking a glucose-containing beverage. This test is used to diagnose diabetes (200 mg/dl and above) or pre-diabetes (between 140 mg/dl and 199 mg/dl)
  • In a random plasma glucose test, blood glucose is checked without regard to when food is consumed. Values of 200 mg/dl or greater in the presence of specific symptoms, such as increased urination or thirst and unexplained weight loss, indicate a diagnosis of diabetes.

Positive test results should be confirmed by repeating the fasting plasma glucose test or the oral glucose tolerance test on a different day. Type 1 diabetes is typically detected much sooner after onset than type 2 disease because the symptoms are dramatic and the need for medical care is immediate and obvious. In contrast, the signs and symptoms of type 2 diabetes can be absent or so mild that the disease may not be diagnosed for 7 to 10 years after the onset resulting in increased risk for complications, such as nerve, eye, and kidney disease, when the disease is finally detected.

Signs and Symptoms of Diabetes

Symptoms Type 1 Diabetes Type 2 Diabetes
Frequent urination X X
Unusual thirst X X
Extreme hunger X X
Unusual weight loss X  
Extreme fatigue X X
Sudden vision changes X X
Fruity, sweet, or wine-like odor on breath X  
Heavy, labored breathing X  
Stupor, unconsciousness X  
Irritability X X
Frequent infections X X
Blurred vision X X
Cuts/bruises that are slow to heal X X
Recurring skin, gum, or bladder infections   X

Table source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)(2004)

Glycemic Index

The glycemic index (GI) rates carbohydrate foods on how quickly blood sugar / glucose levels increase in the 2 - 3 hours after eating as the carbs are converted into glucose. Generally fat or protein doesn’t increase glucose levels.

Eating higher GI foods produces a rapid increase in blood glucose levels, triggering the pancreas to produces insulin. Insulin causes the body’s muscle & liver cells to attempt to store the excess glucose. Imagine insulin as a shuttle, moving glucose from just digested foods into storage. If the digestive system is pumping glucose into the blood stream quicker than insulin can move it into the muscles/liver or glucose stays high too long, the body will convert the excess glucose into fat.

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