Diabetes: Types, Symptoms, Risk Factors, and Treatment

What is there to know about Diabetes?

Diabetes is a chronic condition that results in higher blood glucose or blood sugar levels. The body converts the food into glucose which is released into the bloodstream. It reaches all body organs and cells from the blood and is utilised for energy production. Insulin, a hormone produced by the pancreas, facilitates the transport and utilisation of glucose by the body cells. In diabetic people, either the insulin production is insufficient, or the body cannot use the produced insulin, resulting in higher levels in the blood. 

The blood glucose levels are measured in milligrams of glucose per deciliters of blood (mg/ dL). A fasting glucose level of 100-125 mg/ dL indicates a prediabetic condition and higher levels indicate diabetes. There are minor variations with age, gender and lifestyle. The excess glucose from the blood is removed into urine by the kidneys. The condition is widespread, and currently, 4.3 million British citizens have diabetes. 

Diabetes is a risk factor for issues like kidney disease, heart disease and vision loss and causes many signs like increased urination, thirst, unexplained weight loss, tiredness and blurred vision. There are different types of diabetes, and each style has its causes and risk factors. Type 1 diabetes is due to the damage to the insulin-producing cells in the pancreas; type 2 diabetes is due to insulin resistance in the body, and gestational diabetes is experienced by pregnant women as insulin production fails to cope with the rising demand. 

The risk factors of type 1 diabetes are family history and viral infections, and the risk factors of type 2 diabetes are advanced age, obesity, family history, lack of physical activities, and history of gestational diabetes, non-alcoholic fatty liver disease and belonging to certain ethnicities. The additional risk factors of gestational diabetes are hormonal diseases like polycystic ovarian syndrome (PCOS), a history of type 2 diabetes, giving birth to twin babies or a single baby weighing more than 9 pounds, and being overweight. A comprehensive treatment and control program is essential, including insulin administration, eliminating or reducing the risk factors, diabetes pills and the treatment of related health problems. 

 

What is diabetes?

Diabetes is not a disease but a group of related metabolic conditions characterised by hyperglycemia due to defects in the production or utilization of insulin or both. The damage to the beta cells in the pancreas leading to reduced production of insulin or the lack of responsiveness by the body due to any issues with the hormonal mechanisms of insulin are the causative factors in any diabetes. Chronic hyperglycemia results in long-term dysfunction, damage and the failure of multiple organs like blood vessels, heart, nerves, kidneys and eyes. 

There are different types of diabetes, like type 1, 2, and gestational diabetes. Each type has its causes, risk factors and treatment and prevention options. For proper control and prevention of diabetes, the patients must be aware of various aspects of diabetes like different types of diabetes, aetiology, risk factors, treatment and prevention options.

 

How common is diabetes?

Diabetes is highly prevalent, particularly in the United Kingdom. In 2017, 3.1 million people in the UK were diagnosed with diabetes, 6.66% of the population (GP practice data, 2017). The number has risen to 4.3 million by 2021-22. Most (90 %) cases are of type 2, 2% are of type 1, and the rest comprise the remaining 2%. 

Men are 26% more likely to develop diabetes than women. The cost of prescriptions for diabetes stood at nearly 1 billion pounds in 2016, the largest of any prescription category and more than 10% of total GP prescriptions. Approximately 1 million people have undiagnosed diabetes (Whicher and colleagues, 2020). Diabetes doesn't spare children, with 40,000 children having some type of diabetes and 3,000 new cases yearly. Every 1 out of 6 inpatient hospital admissions has diabetes, responsible for 175 weekly amputations and 530 weekly myocardial infarctions (NHS). 

The risk increases with age, and 50% of diabetics in the UK are over 65 and 25% are over 75. Thus, 10% of all people over 75 years and 14% over 85 years have diabetes (British Geriatrics Society, 2019). The risk of diabetes is closely linked to socioeconomic factors like education, income, healthcare access and access to healthy food.

 

How is diabetes developed?

The development of diabetes involves either the destruction of the beta cells in the pancreas and the resulting low levels of insulin or metabolic abnormalities that cause insulin resistance. Both causes are often present in the same patient, and the differentiation of the primary reason becomes challenging. These issues result in damage, dysfunction and, ultimately, the failure of multiple organs. The eye complications result in retinopathy leading to blindness; the renal complications cause nephropathy and renal failure in severe cases; heart complications cause coronary heart disease and hypertension, nerve related complications cause neuropathy.

 

What is the cause of diabetes?

The cause of diabetes is the disturbance of glucose metabolism. The pancreas, a gland present under the stomach, produces insulin which is released into the blood. Insulin lowers blood glucose levels by increasing its entry and utilisation in the cells. Lower blood glucose causes a decrease in insulin levels through the nervous feedback system. When the glucose levels fall below a certain threshold, the body increases insulin production, mobilises the glycogen stored in the liver or increases glucose absorption through the diet to restore blood glucose levels.

Damage to the pancreas or loss of responsiveness by the body cells to insulin disrupts the glucose homeostasis, resulting in higher blood glucose levels. All types of diabetes have some issues with the production or utilisation of glucose. Some environmental and genetic factors play a role. The causes and risk factors have some differences for each type.

Type 1 diabetes: Type 1 diabetes results from immune-mediated destruction of the beta cells of the pancreas that produce insulin. Some viral infections like human enteroviruses and genetic factors increase the susceptibility to autoimmune diseases. 

Type 2 diabetes: Type 2 diabetes has a more varied aetiology due to the involvement of genetic and lifestyle factors. Lack of physical activity and obesity are the primary causes of insulin resistance. Insulin resistance occurs when the body cells (fat cells, muscle cells and liver cells) cannot use insulin properly or respond poorly to normal insulin levels. Higher levels of insulin are required to get the results. Initially, the pancreas increases insulin production. After some time, it can't cope with the rising demand, and blood glucose levels rise. 

Certain genetic factors increase the risk of all types of diabetes. Genetic factors cause an increased incidence of diabetes in some ethnic groups and races like Pacific Islanders, Native Hawaiians, Asian Americans, African Americans, American Indians etc. As the genes for body weight and obesity are inherited, so is the risk of developing type 2 diabetes. 

Gestational diabetes: Diabetes developing in pregnancy is associated with hormonal changes, lifestyle, and genetic factors. Some placental hormones, like human placental lactogen (HPL), increase insulin resistance in pregnant women. Most women are able to cope with it by increasing insulin production. However, not all women are able to do so. Obesity further adds to the misery; some women are likely to have insulin resistance before pregnancy.

Some other causes of diabetes are;

Genetic mutations: Mutations in the genes involved in insulin production and glucose metabolism has an important role. A type of diabetes called monogenic diabetes is associated with mutations in a single gene. Sometimes, these mutations occur spontaneously or are passed from parents to offspring. These mutations reduce the functional ability of the pancreas. Typical examples are maturity-onset diabetes of the young (MODY) and neonatal diabetes. Neonatal diabetes occurs in infants under 6-month babies, and MODY develops in early childhood. Some genetic diseases like cystic fibrosis cause scar formation in the pancreas and reduce its functionality. 

Hormonal diseases: Some hormonal changes cause under or over-production of insulin and influence insulin sensitivity. Such conditions include Cushing's disease, which occurs due to the overproduction of cortisol; acromegaly, which develops due to the overproduction of growth hormones and hyperthyroidism (the overproduction of thyroid hormones). 

Surgical removal of the pancreas: Some severe conditions like pancreatic trauma, cancer, and pancreatitis cause damage to the pancreas. If it is removed, diabetes develops due to the loss of beta cells. 

Use of certain medications: Some medications cause damage to the beta cells or disturb the working of insulin. These include niacin supplements, diuretics, psychiatric drugs, anti-seizure drugs, drugs used for HIV, glucocorticoids and the medications used to prevent transplant rejection. Statins used for hypercholesterolemia increase the risk of diabetes. 

 

What are the symptoms of diabetes?

Diabetes causes various apparent symptoms. Most symptoms are common to type 1 and type 2 diabetes. These include;

1. Feeling thirstier than usual:  Increased thirst (polydipsia) develops as the body tries to control glucose levels by increasing its excretion in the urine. The urine production increases and the nervous system influence the body to cause more urge to drink water to replenish the loss of water and salts. 
2. Losing weight: Due to lower insulin levels, the body becomes unable to use glucose properly, and mobilises fats and proteins to compensate for energy loss. Moreover, the loss of ketones in the blood and dehydration due to excessive thirst contribute to weight loss. 
3. Feeling weak and exhausted: Weakness and exhaustion result from diabetes issues like dehydration, poor energy production, nutritional imbalances, nerve damage and organ failure. Diabetes causes poor sleep quality as increased urination requires waking up at night.
4. Mood swings: The fluctuations in blood sugar levels cause irritability, fatigue and loss of concentration, all of which cause mood swings. The stress from having a chronic condition, disturbances in hormone levels, poor sleep quality etc., contribute to poor temperament.
5. Increased hunger: Loss of glucose in the urine and poor energy production increases the appetite to compensate for these losses. The disturbances of hormones inclined in hunger regulation and the stress of living with a chronic condition raise need.
6. Getting a lot of infections: Higher blood glucose levels suppress the functions of the immune system and provide a favourable environment for pathogens to increase, which use glucose as food. Some issue like weakness and neuropathy decreases the sensitivity to the pain, and the symptoms of infections are often missed. Factors like poor wound healing and poor circulation due to blood vessel damage increase the risk of diseases. 
7. Slow healing wounds: The ability of the body to heal the wounds is suppressed. High sugar levels disrupt collage production and the formation of new blood vessels in the healing tissues. Both of the mechanisms are essential for wound healing.
8. Having blurry vision: Fluctuations in the blood glucose levels cause changes in the shapes of the eyes lens and fluid levels in the eyes. Diabetic retinopathy due to damage to the small blood vessels in the retina and dry eyes due to reduced tear production are among the significant causes.  
9. Ketones in urine: The mobilisation of body fats to compensate for the loss of energy and glucose causes increased production of ketone bodies, which are the bye products of fat metabolism. Having higher than normal ketones in the blood is indicative of diabetes.
10. Urinating frequently: Increased glucose in the blood causes the body to remove it through urine to restore the glucose levels leading to increased frequency of urination. Increased thirst due to loss of fluids, the diuretic effects of some diabetes medications and bladder neuropathy are among the causes.

Feeling thirstier than usual

Thirst is the need to desire to drink. It is due to a sensation of dryness in the throat and mouth. Thirst helps replenish the fluids and salts lost due to urination, sweating and defecation. Being thirsty and having a dry sensation all the time is a sign of diabetes. 

The loss of control over glucose homeostasis causes increased glucose levels in the blood. The body needs to remove glucose, and the kidneys help by producing more urine. The volume of urine in diabetes increases from normal 1-2 litres to 3-20 litres. The water lost through urine activates the nervous mechanisms responsible for thirst. A person with diabetes is likely to drink 2-3 times more water than an average person and still dehydrated. 

Losing weight 

Weight loss occurs due to the loss of body water, fat or muscles and is either the result of a specific weight loss program or due to involuntary causes like diabetes. In diabetes, the insulin is either not produced (type 1), or the body cannot use it (type 2) correctly. In either of these situations, the glucose produced from the food metabolism stays in the blood and is not used by the body. The body mobilises its fats and muscles to compensate for the energy deficit, leading to unexplained weight loss.  

The loss of water due to increased urination adds to the weight loss as the lost water is often not replenished so fast. So, diabetes is received just like starvation by the body. Losing a few pounds is not a thing to worry about; however, losing 10 pounds or more in a few months causes severe weakness. However, planned weight loss is recommended as losing 2-5% of body weight improves health outcomes in diabetes.

Feeling weak and exhausted 

Weakness is feeling weak, low vigour, and low strength; exhaustion is the state of grave mental and physical tiredness. Weakness and exhaustion are the signs of controlled and uncontrolled diabetes and are sometimes the sole symptoms or occur in combination with various other signs of diabetes. Sometimes, the symptoms persist even if the glucose levels are under control. The relationship between diabetes and weakness and exhaustion is cyclic and bidirectional, with one feeding the other. Diabetes causes weakness, which causes more diabetes, and the vicious cycle continues throughout life. 

Various other factors leading to diabetic weakness are poor nutrition, insufficient social support, side effects of anti-diabetic medications, skipping meals, poor quality sleep or total lack of sleep, inflammation, depression and low levels of testosterone and thyroid hormones. The weakness in diabetes leads to increased self-reported exhaustion, low physical strength, frailty, poor grip strength, and slower walk speed and weight loss. It is a sign that the body is running short of glucose fuel as it is being excreted through urine and is not used by the cells for energy production.

Mood swings

Mood swings are unaccountable and abrupt changes in mood. The phenomenon causes intense and very rapid emotional fluctuations between irritability, anger and depression. The fluctuations in glucose levels influence how a person feels and contributes to mood swings. Some emotional feelings associated with low glucose levels in the blood are sweaty, tiredness, jittering, shakiness, irritation, hunger, nervousness and confusion. 

Likewise, some emotions associated with high glucose levels are lethargy, anxiety, fainting, feeling foggy, sadness, anger and feeling tense. The stress of having a chronic disease and managing it for life is sometimes overwhelming, and a stressed person is less likely to follow any treatment and prevention plan. People with diabetes are often diagnosed with anxiety and depression. All these issues require consultation with a psychiatrist for identification and treatment.

Increased hunger 

Hunger is a feeling of weakness and discomfort caused by a lack of food and is characterised by a strong urge to eat. Often, increased hunger is a natural response to increased physical activities; sometimes, polyphagia (usually high hunger) is a sign of health issues like anxiety, depression and diabetes. It is one of the three most common signs of diabetes, alongside increased thirst and frequent urination. 

Having diabetes means the body cannot extract energy from foods as the glucose is just compiling in the blood and cannot enter the cell. The body perceives it as starvation and stimulates the nervous mechanisms responsible for hunger. Hunger has a dangerous relationship with diabetes as it increases the urge to eat sugary foods, further adding to the glucose levels in the blood. 

Getting a lot of infections 

Infections result when the body's defence systems fail to contain the spread of germs. General weakness, exhaustion, and poor immunity make a person more likely to develop infections. The increased frequency of conditions in diabetics is due to the hyperglycemic environment in the body that favours the immune dysfunctions like loss of functions of immune cells, poor humoral immune response, failure of antioxidant system and increased risk of major and minor vascular and nervous diseases and the use of glucose by the bacteria. 

In one study, people with diabetes had a 21% higher risk of infections than those without diabetes (published in BMC Infectious Diseases, 2018). So, people with diabetes must take precautions during the high-disease-risk season and get vaccinated against all seasonal illnesses.

Slow healing wounds

Wound healing is a natural process in which the body replaces damaged or lost tissues by producing new ones. Usually, wound healing takes place in 4-6 weeks, starting from the inflammation at the wound site and ending with the formation of new blood vessels and intact skin over the wound. Wound healing needs a proper delivery of oxygen and nutrients at the wound site through blood.

Chronic and uncontrolled diabetes negatively influences circulation, which disrupts the flow of essential supplies. Besides poor circulation, issues like a poor immune response to the wounds, damage to the local nerves (neuropathy) and a higher frequency of infections increase the wound healing time, and many wounds do not heal. Sometimes, minor injuries result in prolonged conditions, often requiring amputations.

Having blurry vision

Blurry vision is a problem characterised by obscurity, indistinctness and dimness of objects. It is a sign of damage to the retina, optical nerve, or both. The retina is a sensitive layer inside the eyes where light is focused to form images. Diabetes damages the eyes' lenses and causes vision loss and even blindness in the long run. The leading cause of blindness in diabetic people is diabetic retinopathy. It develops when high blood sugar levels damage the retina's tiny vessels, resulting in blood leakage and swelling, causing impaired vision. 

Sometimes, new blood vessels grow to replace the ruptured ones, but these are abnormal. It commonly affects both eyes. The risk of diabetic retinopathy increases as the time spent with diabetes increases. Some additional factors like higher cholesterol levels, smoking, hypertension, and certain ethnicities (Indigenous Americans, Latin Americans, African Americans and South Asians have a higher risk than White Europeans) increase the risk of retinopathy. Besides blurred vision, some other symptoms like empty or dark areas in the vision, trouble in colour identification and dark shapes or spots in the vision accompany too. 

Ketones in urine

Ketone bodies like acetone, acetoacetate and beta-hydroxybutyrate are the products of lipid metabolism. They are generally produced inside the body, enter the blood and are excreted through urine. Whenever their levels exceed a threshold (0.6 mmol/ L), a condition develops known as ketonuria, characterised by higher levels of Ketones in the urine. The condition in diabetics is known as diabetic ketoacidosis (DKA). 

Carbohydrates like glucose are the instant source of energy. When a person eats fewer carbohydrates or has diabetes (glucose leaves the body unused), the body feels starving and tries to compensate for the situation by mobilisation of fats stored in fatty tissues. As a result, more ketones are produced, leading to ketonuria. Other symptoms of ketonuria include dehydration, thirst, fruity smell from breath, confusion, tiredness, frequent urination, hyperglycemia, and a sweetish smell from urine. 

Urinating frequently

The average urination frequency is 7-8 per day, with minor variations due to physiological causes. A higher frequency is one of the signs of diabetes. When the body does not use the glucose, it compiles in the blood. As the kidneys filter the blood, most glucose is absorbed back into the blood. When glucose levels exceed a certain threshold, the ability of the kidney to reabsorb it is exceeded, and the glucose is lost in the urine. 

To remove glucose, the body increases the urine output from a normal of 1-2 litres per day to 3-20 litres depending upon severity. The water loss through urine causes increased thirst and dehydration, mostly accompanying increased urination. Other related symptoms in the urine are sweat smell, foamy urine, burning sensation in the urine (mainly if there are urinary tract infections UTIs) and urine retention due to the damage to the nerve that innervates the bladder.

 

When do the diabetes symptoms usually appear?

The start of symptoms depends upon the type of diabetes. For type 1, the onset of symptoms is rapid, while it is slow in type 2. For gestational diabetes, the symptoms start at any stage of pregnancy but are more common in the second and third trimesters. 

The onset of symptoms in type 1 is rapid, and depending upon the severity of the damage to the pancreas, the symptoms start within days to weeks. The cause of type 2 diabetes is more persistent, and the symptoms develop accordingly. The severity of symptoms is more in type 1, while the symptoms of type 2 develop more slowly. In gestational diabetes, the glycaemic stress increases and the severity of symptoms increase towards the end of pregnancy.

 

What are the risk factors of diabetes?

Every one out of four people with diabetes doesn’t realise they have it, and only exposure to certain risk factors helps to decide the risk. The risk factors for each type of diabetes are different. Some risk factors, like family history, race or ethnicity and age, are not reversible and are called non-modifiable factors. Other factors like weight, blood pressure, cholesterol levels, smoking, diets, alcoholism, stress and sleep are modifiable, and the patients need efforts to make them adjustable. Some common risk factors of diabetes are;

1. Family diabetes history: Some factors or genes responsible for diabetes are inherited from parents or other biological relatives. So, having a blood relative with diabetes significantly increases the risk of diabetes, and 1-2% of diabetic people in the UK have monogenic diabetes (due to mutations in a single gene).
2. Sleep disorders: For adults, 7-9 hours of regular sleep are required for optimum health of all organs, including the brain and heart. Too low or too high sleep, sleep apnoea and insomnia cause a significant increase in the risk and more than half of the people with type 2 diabetes have reported poor sleep.
3. A lack of engagement in physical activities: Regular engagement in physical activities improves insulin sensitivity, and at least 150 minutes per week of moderate-intensity or 75 minutes weekly of high-intensity exercises reduces the incidence of diabetes and improves cardiovascular health.
4. Hypertension or higher cholesterol: Hypertension (having a blood pressure high than 120/80 mmHg causes damage to the blood vessels and cardiac health and increases the risk of dangerous complications due to diabetes. It improves the chance of diabetes-induced neuropathy. High cholesterol levels compromise the health of blood vessels. 
5. Gestational diabetes: Developing severe diabetes during pregnancy increases the risk of developing diabetes in later life, and 50% of women with diabetes had experienced the first symptom in their pregnancy.
6. Age more than 45 years old: Older age increases the risk of prediabetes and diabetes, particularly type 2 diabetes, mainly in middle-aged people after 40. The age as a factor is a bit unclear as there are more and more incidences of type 2 diabetes in adolescents and even children.
7. Overweight or obesity: The cause is unclear. However, diabetes increases the risk of developing diabetes, and diabetes is more frequent in people with a BMI of 30 or more. Obesity, in fact, is responsible for an 80-85% risk of type 2 diabetes and the risk of type 2 diabetes in obese people and is much higher than in people with a BMI of 22 or less.
8. Have polycystic ovary syndrome (PCOS): Many women with PCOS often have insulin resistance, and more than 50% of women with PCOS experience type 2 diabetes before the age of 40. PCOS cause female infertility, and if such females become pregnant, there is a higher risk of gestational diabetes, which puts the lives of both the baby and the mother at risk. PCOS increases the risk of obesity and other related health issues like heart disease, hypertension, hypercholesterolemia, sleep apnoea, stroke, anxiety and depression, many of which are linked to the onset and severity of diabetes.

Family diabetes history

Family history has a solid link to the risk of diabetes, and it tends to run in families. For both type 1 and type 2 diabetes, the risk factors are inherited from both parents. At least 120 genes influence insulin, diabetes and glucose levels. The inherited factors, however, are not enough to cause diabetes, and they must be triggered by some environmental triggers like viruses and cold weather (the incidence of type 1 is higher in the cold regions). 

On average, the risk of a baby developing type 1 diabetes is 1 in 17 if only the father has diabetes and 1 in 25 if the mother has diabetes. If both of the parents have type 1 diabetes, the chance for a child is between 1 into 10 to 1 into 4. 

The genetics of diabetes is, however, a complex topic. Type 2 diabetes is more related to genetic factors than type 1. Due to lifestyle factors, it is often difficult to distinguish if diabetes is due to genetic or environmental factors. Compared to type 1, it is feasible to delay the development of type 2 diabetes by lifestyle and nutritional management. 

Sleep disorders

Sleep disorders like insomnia, snoring, sleep apnoea, disorders of circadian rhythm, excessive sleep, parasomnias, and movement disorders cause various negative changes in the body, including diabetes. One-third of the people with diabetes have concurrent sleeping issues. Sleep restrictions cause inhibition of the secretion of insulin and increase insulin resistance. Sleep deprivation causes the mobilisation of body fats and the release of fatty acids, which result in fat deposition in the muscles and liver, further adding to insulin resistance. 

The increased cortisol levels and low-grade inflammation in sleep-deprived people add to the problem. There are some indirect causes. For example, waking up longer during sleep disorders often result in more irregular eating and weight gain, which are substantial risk factors for type 2 diabetes. The fatigue due to sleep deprivation reduces the urge and motivation to exercise, which increases the risk of weight gain. Sleeping very late is related to poor glycaemic control and higher diabetes risk. 

There is hormonal backing as the sleep hormone melatonin influences insulin secretion and sensitivity, and lower and varying levels of melatonin are more linked to the risk of diabetes. So, getting proper sleep and going to bed at the right time must be included in the diabetes management program.

A lack of engagement in physical activities

Modern lifestyle, particularly a restricted work routine, lack of social mobility and higher stress levels, negatively influence the body's homeostasis. A sedentary lifestyle and lack of physical activities add to the risk of diabetes by promoting insulin resistance. Lack of physical activity results in weight gain, and it is known that 1 kg of weight gain increases the risk of developing diabetes by 9%. Some other issues associated with the sedentary lifestyle are poor mental health, lipid disorders, osteoporosis, colon cancer and hypertension, all of which contribute to diabetes. 

Lack of physical activity has a cyclic relationship with diabetes, with one exacerbating the other. People with chronic diseases like arthritis, bone pain, heart disease etc., are less likely to move and have a considerably higher risk of diabetes.

Hypertension or High cholesterol

Hypertension means having a diastolic or systolic blood pressure equal to or more than 90 mmHg and 140 mmHg against average values of 80 and 120 mmHg, respectively. Both diabetes and hypertension share several common risk factors and causes, and the presence of one issue increases the risk and severity of the other. People with hypertension have insulin resistance and a greater chance of becoming diabetic than others. The link is attributed to various issues associated with hyperandrogenism (higher androgen levels) like inflammation, immune system disturbances, increased oxidative stress, obesity and thickening of blood vessels. 

All these factors increase the risk of diabetes, although hypertension is not a direct cause. Diabetes and hypertension combine to increase the risk of kidney diseases, cardiovascular diseases, stroke, heart attacks and eye problems. 

Having higher cholesterol levels or hyperglycemia is a condition in which total cholesterol levels in the serum exceed 190 mg/ dL, and it is a risk factor for many diseases. Having a higher cholesterol level, particularly bad (LDL) cholesterol, causes the development of plagues in the blood vessels, which disrupt the blood flow and reduce insulin delivery at the desired sites, resulting in insulin resistance. The relationship is cyclic; higher glucose levels increase the risk of hypercholesterolemia, and the degenerative cycle continues.

Gestational diabetes

Gestational diabetes is diabetes that develops in pregnancy, particularly in the last two trimesters. The growing demand for glucose during pregnancy needs higher insulin levels. The pancreas increases insulin production to a certain level but ultimately fails to keep the desired production levels in some women, resulting in diabetes. Having gestational diabetes is a risk factor for developing type 2 diabetes after pregnancy, and 50% of women experiencing gestational diabetes develop type 2 diabetes in the next 5-10 years.

For many women, gestational diabetes ends after the pregnancy, while for half of them, it induces insulin resistance that persists after the end of pregnancy. The risk is notably higher for older and obese women. It has a genetic predisposition as the babies of such women are more likely to develop obesity in teenage and childhood and have a greater risk of type 2 diabetes in later life. 

 Age more than 45 years old

Ageing induces several negative changes in the body, which increase the risk of diabetes. The population of elders is increasing, particularly in developed countries like the UK. With advancing age, the lean body mass decreases, and the body fat, particularly around the visceral organs, increases; the changing body composition favours insulin resistance. Ageing lowers the beta cells' compensation in the pancreas, resulting in lower insulin production. 

The beta cells become more prone to apoptosis (cell death), and their proliferative capacity decreases. Recent research has noted that decreased mitochondrial functions with age cause insulin resistance. Another characteristic feature of ageing is the presence of low-level and chronic inflammation in the body, which causes glucose intolerance and beta-cell dysfunction. The age of development of type 2 diabetes influences health outcomes, and an inverse relationship exists between the age at which diabetes develops and its potential health effects. Diabetes developing at lower age results in more severe health problems. It causes early damage to the beta cells, resulting in the development of type 1 diabetes and a considerably shorter lifespan. Moreover, ageing causes multiple health issues like higher cholesterol and hypertension, which make diabetes control very difficult. 

Overweight or obesity 

Being overweight is having a BMI of 25 or more, which ultimately progresses to obesity when the BMI exceeds 30. So, being overweight means having a weight higher than the expected normal for the age and gender and obesity is marked by the deposition of excessive fats in the body resulting in a poor quality of life and increased risk of hypertension, diabetes, coronary heart disease etc. 

Obesity is a considerable risk factor for diabetes, and 80% of obese people develop type 2 diabetes at some point. Excessive body fat, particularly around the abdomen, increases the risk of developing type 2 diabetes. Excessive body fat causes the release of inflammatory chemicals that result in lower insulin sensitivity, an essential hallmark of type 2 diabetes. Obesity induces various changes in metabolism. The increased fat deposition causes increased blood fat molecules that negatively influence the insulin-sensitive cells and causes insulin resistance. 

Obesity causes a considerable risk of developing prediabetic conditions, which in most cases progress to diabetes. Obesity results from various other risk factors of diabetes like lack of proper sleep, smoking, stress, unhealthy lifestyle and sedentary lifestyle. Nevertheless, obesity doesn't necessarily mean diabetes always develops, and other factors like ethnicity, age, and genetics have a role, and many obese people don't develop diabetes.

Having Polycystic ovary syndrome (PCOS)

In PCOS, various small, fluid-filled cysts form on the ovaries, ovaries produce higher amounts of male hormones (androgens), and an egg is not released from the ovary. When ovulation (release of an egg) doesn't occur, cysts are formed that release androgens. PCOS causes Various symptoms like missed, irregular and light periods, excessive hair growth in females, particularly on the back, stomach and chest, weight gain, especially around the abdomen, oily skin, hair thinning etc. 

PCOS causes increased fat deposition in the body, resulting in insulin resistance. Consequently, more than 30-40% of women with PCOS develop diabetes before 40 years of age (NIH, 2023). Such women are likely to develop gestational diabetes, which causes an increased risk of type 2 diabetes in later life. Other risk factors of diabetes associated with PCOS are stroke, sleep apnea, hypercholesterolemia and a higher risk of heart disease. 

The higher levels of androgens in the PCOS stimulate insulin production, which results in insulin resistance. The relationship between prediabetes and diabetes, and PCOS is bidirectional, and higher insulin levels cause PCOS. Higher insulin levels worsen the symptoms of PCOS as insulin stimulates the androgen production by the ovaries and the sex hormone binding globulin (SHBG) from the liver, which further adds to the PCOS symptoms. 

 

What are the Complications of Diabetes?

Higher blood glucose levels, particularly for long durations, cause damage to various body parts, causing multiple complications. The complications of diabetes are classified into two types;

Acute complications: These are short-term complications that occur at any time and include; 

• Waves of hyper and hypoglycemia: The blood glucose levels fluctuate between various extremes, making management difficult.  
• Hyperosmolar hyperglycemic state (HHS): It is a severe condition caused by very high blood sugar levels for long periods and results in severe dehydration, changes in consciousness ranging from mild lethargy to coma and death and a greater risk of other types of diabetes. 

The death rate from HHS is high and varies between 5-20%, with high values for older adults (Anna Milanesi, MD). It is more common in type 2 diabetes and is the initial clinical presentation in 7-17% of the cases, and is rare in type 2 diabetes. 

• Diabetic ketoacidosis (DKA): It is an extreme emergency in which low insulin and high glucose levels cause excessive production of ketone bodies. Ketones are produced when the lack of utilisation of glucose is perceived as starvation by the body and causes the liver to break down stored fat to release glucose. It is more common in type 1 diabetes but develops in type 2 diabetes too. 

The symptoms of DKA are increased thirst and urination, fast and deep breathing, dry mouth and skin, facial flushing, fruity smell from breath, muscle aches and stiffness, headaches, tiredness, vomiting, nausea and stomach pain. 

Chronic complications: These complications develop slowly over the long run, becoming severe and life-threatening if ignored. These include;

• Retinopathy (eye problems): Some people with diabetes develop retinopathy which damages the sensitive retina of the eyes and causes poor eyesight. It must be treated to prevent permanent loss of vision. It develops in both types of diabetes and is experienced by more than 20% of people with type 2 diabetes, and the risk is even higher (95-97%) in the type 1 diabetic. It is the most common cause of blindness in adults. 
• Foot problems: Foot problems are often severe and lead to amputations. The raised blood glucose levels cause damage to the local blood vessels and nerves, preventing the cuts and sores from healing properly. The nerve damage causes loss of sensation, pain, tingling and numbness in the feet. Any signs on the feet must be reported to the doctor.
• Stroke and heart attacks: Having hyperglycemia for a very long time causes damage to the heart's blood vessels, resulting in strokes and heart attacks. Having diabetes increases the risk of heart attacks and stroke by 2 folds. 
• Kidney issues:  In the long run, hyperglycemia damages the kidney, causing nephropathy as the kidneys have to work harder to remove extra glucose from the body. It develops in 30-40% of people with diabetes (NIH). 
•  Male sexual dysfunction: Damage to the nerves and blood vessels of the male reproductive organs makes a person unable to achieve sexual arousal and enjoy regular sex. The erectile dysfunction often leads to impotence. Diabetics have a threefold higher risk of experiencing erectile dysfunctions than people without diabetes (Maria Ida Maiorino, University of Naples).
• Female sexual dysfunction: Damage to the nerves and blood vessels in the female reproductive organs cause loss of functions and sensation. There is a higher risk of urinary tract infections and vaginal thrush in women with hyperglycemia and hypertension.
• Risk of cancers: Diabetes increases the risk of certain cancers. Likewise, some anticancer treatments negatively influence the diabetes control program. The risk of bladder, breast, endometrial, colorectal, pancreatic and liver cancer is considerably higher. 
• Neuropathy (nerve damage): Complications of hyperglycemia often damage one or more nerves, making them unable to perform their functions and resulting in loss of parts of different body organs and sensations. It affects as much as 50% of patients of both types of diabetes mellitus, and the exact symptoms depend upon the nerves involved.  
• Mouth problems: Too high glucose levels in the blood cause higher glucose levels in the saliva. Opportunistic bacteria in the mouth seize the opportunity to proliferate and cause damage to the gums and enamel. The blood vessels in the gums become prone to damage resulting in oral infections and bleeding.

 

Can high blood sugar levels induce diabetic complications?

Yes, higher sugar levels in the blood, particularly for a long time, cause various dangerous complications like cardiovascular complications, neuropathies, nephropathy, retinopathy, neuropathy and foot complications. Having occasional highs and lows is not so damaging; these complications result from long-term exposure to high levels. Complications are experienced with low glucose levels (hypoglycaemia), too, including hunger, dizziness, confusion, irritability, anxiety, nervousness, sweating, shaking, increased heartbeat and seizures and coma in severe cases (glucose levels 41-49 mg/ dL or lower).  

To avoid these complications and prevent permanent damage to the body organs, loss of functions and severe amputations, controlling the blood glucose levels and preventing long-term exposure to hyperglycemia is necessary.

 

What are the types of diabetes?

Diabetes is of various types, although all kinds of diabetes involve some disturbances of glucose metabolism and higher glucose levels in the blood. Many signs and symptoms are familiar to them. Three common types of diabetes are;

Type 1 diabetes: It results from damage to the pancreas due to autoimmune conditions, infections, accidents or other causes resulting in lower or no insulin production. Both genetic and environmental factors are involved. However, the role of lifestyle factors is minimal. Type 1 diabetes is experienced at anything age and is the cause of diabetes at a young age. It accounts for 8% of all cases of diabetes.

Type 2 diabetes: It results from insulin resistance in the body tissues, which means the pancreas produces desired insulin levels, but body cells fail to respond to it. Lack of responsiveness causes the pancreas to increase production, and ultimately, it fails to keep up with the rising demand. The exact cause is poorly understood, and some factors like obesity and overweight, sedentary lifestyle, diets and genetic factors have a role. It accounts for 90% of total diabetes cases and is mainly observed in advanced age. 

Gestational diabetes: It is due to various insulin-blocking hormones (like human placental lactogen) produced during pregnancy. It is more common in pregnant women in the second and third trimesters of pregnancy and those with a family history of diabetes, obesity and pre-existing prediabetic conditions. Most women recover their glycaemic control at the end of pregnancy, while it develops into type 2 diabetes in 50% of the women. 

Miscellaneous types of diabetes: Type 1, 2 and gestational diabetes are the major but not the only types. Here are some other types which develop due to various causes. These are;

• Neonatal diabetes: It is diagnosed in less than 6-month babies and is an inherited condition. Such babies have genetic changes that influence their insulin production in them. 
• Maturity onset diabetes of the young (MODY): It is a familial type of diabetes due to genetic factors. However, children with genetic mutations develop diabetes as they mature (before 25 years of age). 
• Disease-induced diabetes: Several diseases induce diabetes by damaging the pancreas or reducing its insulin-producing ability. These include pancreatitis, pancreatic surgery, haemochromatosis, pancreatic ductal adenocarcinoma, pancreatic cancer and cystic fibrosis. It is often referred to as type 3c diabetes. 
• Steroid-induced diabetes: Taking higher doses of steroids for long durations disturbs the production and levels of various hormones, including insulin. 
• Monogenic Diabetes: It is diabetes that is caused by genetic changes, changes explicitly (mutations) in a single gene. Neonatal diabetes and MODY are included among monogenic diabetes. In contrast, types 1 and 2 are caused by multiple mutations and environmental factors (in type 2).
• Latent autoimmune diabetes in adults (LADA): Some researchers call it type 1.5 diabetes. It is because although it is caused by autoimmune damage to the pancreas, it progresses more slowly than traditional type 1 diabetes. It is confused with type 2, too, as the pancreas continues to produce insulin for a considerable time. 

Novel types of diabetes: Researchers consider Some types novel types, but more information is needed. These types include;

• Type 3 diabetes: It stems from the theory that there exists a link between Alzheimer’s disease (a type of memory loss disease) and insulin resistance, as highlighted by researchers in Brazil in 2018. It was noted that the risk of Alzheimer’s is higher in people with type 2 diabetes. More research is ongoing to understand the link between type 2 diabetes and Alzheimer’s disease. 
• Type 4 diabetes is a proposed type to explain the development of diabetes in older people, which resembles type 2 due to insulin resistance but are not overweight or obese. It is more related to age-related factors than body weight. 

How is diabetes being diagnosed?

Clinical signs provide initial hints, and doctors rely on diagnostic tests to detect diabetes, monitor blood glucose levels and tell if a person has pre-diabetic conditions, gestational diabetes or type 1 or 2. Different tests used for the diagnosis of prediabetes and diabetes are;

Fasting blood glucose level

It measures the glucose levels in the blood after overnight fasting. It is conducted after fasting for at least 8-12 hours or more, as advised by the healthcare provider. A value less than 100 mg/ dL means normal glucose levels, 100-125 mg/ dL means a prediabetic condition and higher values mean diabetes. There are some minor variations due to age, gender and lifestyle. 

Random glucose test

It detects the level of glucose in the blood at any time and is conducted during emergencies or whenever asked by the healthcare provider. A value of less than 140 mg/ dL means normal, 140-199 mg/ dL means prediabetic condition and higher levels mean diabetes. It allows the doctor to see how the body responds to the glycaemic challenge like a meal and helps to formulate nutritional modifications.

A1C (Haenoglobin A1C or HbA1c) test

It measures the average glucose levels in the blood over 2-3 months. An A1C value of less than 5.7% means average results; 5.7-6.4% values represent the prediabetic condition, and higher values indicate diabetes. Due to regular variations in blood glucose levels, doctors are more interested in seeing the average levels over months to diagnose and formulate recommendations for control and management.  

Glucose tolerance test (GTT)

It measures the changes in blood glucose levels over time after a strong glycaemic challenge, like after taking a glucose solution. A common glycaemic challenge is to take 75 gm of glucose dissolved in 250 ml of water. The test is started after overnight fasting and fasting sugar levels are measured. After drinking the glucose solution, the glucose levels are measured after 1, 2 and 3 hours or more if necessary. The test values conducted after 2 hours are used for diagnosis using the criteria used above for random glucose tests.

Immunological testing 

It is done in case of type 1 diabetes if the suspected cause is the autoimmune damage to the pancreas and detects the presence of autoantibodies in the blood. Another test conducted for type 1 diabetes is testing for ketones in the urine, which are elevated due to increased fat metabolism. Immunological testing is required before invasive treatments like pancreatic islet transplantations to avoid the risk of rejection of an immunological transplant.  

Diagnosis of gestational diabetes 

Blood tests are used for the diagnosis of gestational diabetes. Testing is done between 24-28 weeks of pregnancy and earlier if the risk of gestational diabetes is higher. A higher blood glucose level in the initial days of pregnancy means the woman has type 1 or 2 diabetes, not gestational diabetes. Both the random glucose test and glucose tolerance test are helpful for gestational diabetes.  

Genetic testing is helpful for the diagnosis of monogenic diabetes, which is due to mutations in a single diabetes gene (over 120 different genes influence diabetes?). 

Irrespective of the type of diabetes a person has, healthcare providers rely on continuous monitoring using different tests for better management of diabetes. The patients are encouraged to use digital devices and applications to monitor their glucose levels. These applications allow patients to continuously monitor their health parameters and are helpful for doctors.

 

How is diabetes prevented?

Preventive measures are helpful for prediabetic conditions and type 2 diabetes. Currently, no preventive measures are helpful for type 1 diabetes, and researchers are struggling to find some preventative measures. As 90% of cases of diabetes are related to type 2, lifestyle changes and preventive measures help manage diabetes and prevent dangerous complications. The goal of these preventative measures is to stay active and stay lean. Some valuable steps are;

1. Weight management: Weight is the most important cause of type 2 diabetes. An overweight person has a 7 times higher risk of developing diabetes, while for the obese person, the risk becomes 20-40 times higher (Frank B. and colleagues, 2001). Therefore, losing 5-10% of the body weight reduces the risk of type 2 diabetes by half. 
2. Stay physically active: Working out improves the ability of muscles to use insulin properly and reduces the stress on the pancreas to produce more insulin. Cumbersome exercise is unnecessary to achieve the benefits, and just 30 minutes of regular brisk walking lowers the risk of type 2 diabetes by 30%. 
3. Dietary improvements: Some dietary modifications like proffering whole grains and whole grain-based products over processed carbohydrates and refined grains, skipping coffee, tea and sugary drinks, consuming healthy fats, limiting the intake of processed meats and red meat and increasing the intake of seafood, poultry products, whole grains, beans and nuts are beneficial in the diabetes management. An important thing to consider is to use foods of low glycaemic index and avoid those with high glycaemic index. Eat smaller portions and add plenty of vegetables and fruits to the diet. 
4. Add more fibre to the diet: Fibrous foods improve weight and help lower blood glucose levels. Include a variety of fibre-rich and healthy foods in the diet, including leafy green vegetables like broccoli and cauliflower, fruits, peppers, tomatoes, legumes, e.g., lentils, chickpeas and beans etc. Fibrous foods lower glucose absorption into the blood and reduce inflammation and hypertension, the other risk factors of diabetes. Fibrous foods lower the appetite due to their filling effects.
5. Quit smoking: Smoking is closely linked to various health problems like type 2 diabetes, and average smokers have a 50% higher risk of developing diabetes than no smokers, and the risk increases with increasing smoking frequency. So, the health risks of smoking extend beyond the damage to respiratory epithelium and lung cancer. 
6. Reduce alcohol consumption: Light to moderate use of alcohol (at the most 2 drinks daily for men and 1 for women) helps in diabetes by improving the working efficiency of insulin. However, excessive drinking increases the risk. A person without diabetes doesn't need to start drinking to get these benefits and must resort to other diabetes control measures.
7. Regularly consult the healthcare provider: Regular consultation and testing help avoid complications of chronic diabetes. The doctors are able to guide the patients about more preventive measures and prescribe necessary treatment when needed. 
8. Have a health plan before planning a pregnancy: To prevent gestational diabetes, the women at risk must lose weight through physical activities to achieve the ideal BMI of 18.5-24.9. Women who are already pregnant must not lose weight as it is harmful to the baby. Pregnant women gain weight. However, very rapid weight gain is not a healthy sign and must be consulted with the doctor.
9. Stress management: Stress is not a direct cause of diabetes. However, it is a risk factor for type 2 and gestational diabetes. The hormones released in response to stress cause low insulin levels by suppressing the insulin-producing cells in the pancreas. Therefore, stress management techniques like regular exercise, yoga, progressive muscle relaxation, meditation, deep breathing, guided imagery, aromatherapy, massage, mindfulness and walking are helpful for diabetes prevention.

Can avoiding sugar prevent diabetes?

No, avoiding sugar is not enough to prevent diabetes, and a comprehensive program is needed. Nevertheless, it is a valuable measure to reduce the risk, particularly for type 2 and gestational diabetes. Higher sugar consumption causes higher weight gain and obesity, an influential risk factor for type 2 diabetes. Consuming sugary-rich foods like drinks causes a sudden spike in blood glucose levels and the resulting increased stress on the beta cells of the pancreas, increasing the risk of type 1 diabetes. 

Therefore, just relying on sugar intake is not recommended, and a complete treatment and prevention plan for diabetes, including physical activities, stress management and overall diet management, are essential aspects of diabetes prevention. The patients (or the suspected patients) must consult the doctor for better advice and management plans.

What is the treatment for diabetes?

Different treatments are available for treating and managing diabetes, and the choice depends upon the type of diabetes, the health status of the patients, the extent of the issues and other factors. Some common treatments are;

Insulin administration

Insulin is helpful for patients with type 1 diabetes and, in some cases, type 2 diabetes. All patients with type 2 diabetes don't need insulin; only those with chronic type 2 diabetes are often recommended. Insulin administration helps to keep the glucose levels in check. 

Different insulins are short-acting, long-acting, rapid-acting, intermediate-acting and mixed. To monitor the dose, the blood glucose monitors are used. The correct dosage is essential as excessive quantities cause deficient glucose levels (hypoglycemia), causing shaking, sweating and nausea. 

Insulin dosing: The insulin dosing is measured in the insulin units. The doctors first calculate the insulin sensitivity or correction factor to calculate the insulin dosage. The correction factor measures how many units of insulin are required to cause the desired decrease in blood glucose levels. It ranges between 30-100 mg/ dL (average: 50 mg/ dL). For example, if the correction factor for a person is 1 unit per 50 mg/ dL, and the fasting glucose level is 200 mg/ dL, it means 4 units of insulin are required to achieve the desired insulin level. 

Another method is carbohydrate counting, in which healthcare providers calculate the insulin-to-carbohydrate ratio. For example, if that ratio is 1 unit of insulin per 10 grams of carbohydrates, the patient must take 4 units before consuming a diet containing 40g of glucose. Nearly 2/3 of the required dose is given before breakfast and the remaining before dinner. 

Use of insulin pumps: The insulin pumps are a handy option for managing the doses compared to insulin pen injections. It provides more flexibility in controlling glucose levels.

Islet cell transplant 

Islet cell transplant is used to cure type 1 diabetes in patients who have experienced two or more 2 hypos in the past 2 years. It is, however, not suitable for overweight and obese people, people having kidney dysfunction or people requiring high doses of insulin (more than 50 units daily). During the transplantation process, the pancreatic islets containing alpha and beta cells are removed from the donor's pancreas (usually a deceased person). The islets are purified and counted (an average of 400,000) islets are transplanted). The islets are then transplanted into the liver of the recipient. 

Over a few weeks, blood vessels connect these islets to the blood supply of the liver, and they start producing hormones that are released into circulation. It is practical and reduces the frequency of hypos, improves the quality of life and allows better control over blood glucose levels. It is not suitable for people with severe diabetes as they need to continue using insulin after the transplant. It has some risks like infections and a higher risk of some cancers, and the patients need to use immunosuppressive drugs for a long time to avoid transplant rejection. 

Diabetes medications 

Different diabetes medications are available, which use other mechanisms to work. Only some medicines are helpful for some people, and the doctor must decide on their use. Some drugs commonly used are;

Metformin: It is used for treating type 2 diabetes when lifestyle measures are not alone effective. It is a member of the biguanide group of drugs extensively used for treating diabetes.

Sulphonylureas: Different drugs in the sulphonylureas family stimulate the beta cells in the pancreas to produce more insulin. They improve the working efficiency of insulin too. 

Acarbose (Glucobay®): It is an alpha-glucosidase inhibitor and slows down food absorption after a meal and thus prevents an abrupt increase in blood glucose levels. 

Nateglinide (Starlix®) and Repaglinide (Prandin®): These are the prandial glucose regulators taken 30 minutes before a meal and stimulate the pancreas to increase insulin production. They must not be used in case of a missed meal due to the risk of hypoglycemia. 

Statins: Statins are used to lower harmful cholesterol levels and help manage glucose levels, as hypercholesterolemia is a risk factor for diabetes.

SGLT2 inhibitors: These drugs lower the glucose absorption from the kidneys and promote their removal into the urine, causing lower levels in the blood. These drugs are taken daily and cause increased urine glucose levels. Common brands are Steglatro®, Jardiance®, Invokana® and Forxiga®. 

Gliptins (DPP-4 inhibitors): These drugs block an enzyme DPP-4 that destroys a hormone called incretin. Incretins are gut hormones that are released by the enteroendocrine cells within a few minutes after a meal. Different brands are Galvus®, Janumet® and Januvia®. 

Incretin mimetics: The incretin mimetics work like incretin, the hormone that causes increased insulin production and lower appetite. Different brands are available that are taken twice daily, daily or weekly. Brands available are Victoza®, Byetta® and Ozempic®. 

Pioglitazone: These drugs are called the glitazones or thiazolidinediones. They are taken once or twice daily and improve insulin efficiency and protect the insulin-producing cells in the pancreas.

 

Does exercise reduce blood sugar?

Yes, physical exercise reduces blood sugar levels depending on duration, intensity and type. It lowers blood glucose after 24 hours or more by improving insulin sensitivity in the body. The patients need to be familiar with how the body responds to the exercises and continue monitoring glucose levels to get maximum benefits from the activity. People taking insulin or other diabetes medications need to adjust their exercises with the intake of carbohydrates and drugs to avoid the risk of dangerous hypocalcemia. 

For training, the blood glucose levels must not be lower than 100 mg/ dL, and if lower, the patients must increase it before continuing the physical activities. If there is a risk of hypocalcemia during exercise, the patients must consult the doctor for a better treatment plan. Patients experiencing several hypers and hypos must consult the doctor before choosing any exercise plan.

 

 How does chronic stress affect insulin resistance and blood sugar in people with diabetes?

Yes, high-stress levels lower insulin levels by suppressing the activities of insulin-producing cells in the pancreas and contribute to the development of diabetes. Some people resort to overeating when stressed, leading to weight gain, higher glucose levels and more insulin resistance. Type 2 diabetes is often initiated by physical and psychological stress, and the central and peripheral nervous systems are involved in the process. 

The release of glucocorticoids and catecholamines during stress causes insulin resistance and increases the insulin requirement for the same diet and exercise levels. For some people, a permanent loss of functions of the pancreas develops as the pancreas fails to meet the demand. The hormones released in response to stress cause an increase in blood sugar levels. In healthy individuals, the body adapts to the stress. However, in the long run, the body becomes resistant—diabetes results in abnormalities in regulating stress hormones. 

The glucocorticoids released in response to stress cause gluconeogenesis, i.e., converting glycogen stored in the liver into glucose to cause abrupt energy production. Furthermore, it inhibits the absorption and utilisation of glucose by the fatty tissues and muscles and thus, hyperglycemia is the most prevalent and quick side effect of chronic stress. Glucocorticoids work as antagonists to the metabolic effects of insulin.

 

Can type 1 diabetics control their blood sugar with insulin?

Yes, type 1 diabetes is due to low insulin production due to damage to the beta cells in the pancreas, and therefore, people with type 1 diabetes are able to control their glucose levels using insulin. Insulin pumps or injections are helpful for insulin administration. During treatment, an appropriate amount of insulin is administrated regularly while the blood glucose levels are routinely administered to keep glucose levels in balance. 

Different types of insulin available for treating type 1 diabetes are long-acting, short-acting, medium acting and rapid-acting. The choice depends upon individual factors and the doctor's recommendations. However, it must be remembered that using insulin for type 1 diabetes does not cure the condition. It just allows the person to keep optimum glucose levels for better health.

 

What is the difference between type 1 and type 2 diabetes?

Both types of diabetes have the same clinical manifestations, i.e., increased blood glucose levels. However, some crucial differences must be understood. The important differences are;

Incidence rates: Type 1 diabetes is vastly less common and accounts for 8% of cases of diabetes in the UK, while 90% of patients have type 2 diabetes. 

Causative factors: Type 1 diabetes is related to autoimmune damage to the pancreas, pancreas removal or pancreatic injuries, and is more common in young age and childhood. Type 2 diabetes, on the other hand, is more common in the elderly and middle-aged people and results from insulin resistance due to a variety of reasons like lack of physical exercise, obesity and poor nutritional habits. Type 1 is more, on the other hand, related to abnormalities of the immune system, genetic factors and environmental factors. 

Production of autoantibodies in type 1: During type 1 diabetes, the antibodies are produced in the body against the insulin-producing beta cells, and there is no pancreas production in severe cases. No such autoantibodies are produced in type 2 diabetes. 

Involvement of pancreas: Type 2 diabetes is not linked to the pancreas. The pancreas is there and often produces average amounts of insulin, but the body has become resistant to insulin and doesn't respond to it anymore. 

Treatment and prevention: Type 1 is not preventable, while type 2 diabetes is preventable using lifestyle modifications and better nutrition.