Diabetes

Diagnosis

Unlike type 1 diabetes whose symptoms occur and grow worse suddenly, the other types of diabetes and prediabetes mostly do not cause symptoms right away. These diseases also tend to grow worse just slowly, which makes them hard to be detected.

The following groups of people are at risk of developing diabetes and should receive a diabetes screening:

• Those that have a body mass index of over 25 (23 for Asian Americans) are at a higher risk of diabetes if they have risk factors include hypertension, high cholesterol in the blood, lack of movement, a history of polycystic ovary syndrome or heart disease, and a family history of diabetes.
• Those older than 35 years with normal initial blood sugar screening are recommended to receive a screening test once in three years.
• Women with a history of gestational diabetes recommended to receive a screening test every three years.
• Those with a diagnosed prediabetes: should receive a test every year.
• Those with HIV.

Tests for type 1 and type 2 diabetes and prediabetes

• Glycated hemoglobin (A1C) test: shows the fasting blood sugar level, which is the average blood sugar level of 2-3 months. An abnormally high A1C level means too much sugar is attached to hemoglobin, which is the protein that carries oxygen in red blood cells.

An A1C level of at least 6.5% on two separate tests indicates that you are diabetic. The prediabetes range is 5.7%-6.4% and the normal one is under 5.7%.

• Random blood sugar test: shows a non-fasting sugar level in the blood collected for the test. You may be diabetic if the sugar level reaches or exceeds 200 milligrams per deciliter (mg/dL), or 11.1 millimoles per liter (mmol/L).
• Fasting blood sugar test: The blood sample will be taken following an overnight fasting, which will check the sugar level in the blood. A healthy fasting blood sugar level is under 100 mg/dL (5.6 mmol/L). Prediabetes is defined as having a fasting blood sugar level between 100 and 125 mg/dL (5.6 and 6.9 mmol/L). You have diabetes if it is 126 mg/dL (7 mmol/L) or above on two separate tests.
• Oral glucose tolerance test: shows the fasting blood sugar level. Then the doctor will let you drink a sugary liquid and test blood sugar levels again in the next two hours.

The normal range is less than 140 mg/dL (7.8 mmol/L), but you may be diabetic if the level rises to over 200 mg/dL (11.1 mmol/L) after two hours. The prediabetes range is 140-199 mg/dL (7.8-11.0 mmol/L).

For people at risk of type 1 diabetes, a urine test may be done to see if there are ketones in the urine which is an indicator of the disease as they are byproduct from the breakdown of muscle and fat to produce energy.

A test to look for autoantibodies, or destructive immune system cells, might also be done as the cells can raise the risk of type 1 diabetes.

The risk of gestational diabetes was assessed in pregnant women. If the risk of gestational diabetes is high, a screening test for diabetes will probably be done during the first prenatal visit. And if the risk of gestational diabetes is average, a screening test will be done during the second trimester.

Treatment

There are many ways to treat diabetes, depending on the disease’s type as follows:

Treatments for all types of diabetes

• Healthy eating: recommended to eat less saturated fats, simple carbohydrates and desserts. Food high in sugar should be consumed in the minimum amount instead should intake more food high in nutrition and fiber and low in fat and calories. For those who have type 1 diabetes or use insulin, the food-based approach may include carbohydrate counting.
• Exercising. Exercising, or any physical activities in general, uses sugar to fuel energy. That is why exercising allows a greater amount of sugar to be moved from the bloodstream into the cells. This means those who regularly exercise are more insulin-sensitive as their body needs less insulin to move sugar into cells.

To gain the most benefit from exercising, you are recommended to do it daily. It can be only a simple activity that you can easily enjoy, such as walking, swimming and biking. You are supposed to exercise not less than 30 minutes per day, or 150 minutes per week. You can separate the exercising routine in bouts over a day.

Treatments for type 1 and type 2 diabetes

Type 1 diabetes can be treated in many ways, including receiving injected insulin, using an insulin pump, regularly getting a blood sugar check and counting the carbohydrate intake. In certain cases, patients with type 1 diabetes may also need a pancreas transplant or islet cell transplant.
Those with type 2 diabetes may control their disease by opting for a healthier lifestyle, monitoring the blood sugar level as well as taking oral diabetes medications and/or injecting insulin.

Monitoring blood sugar: helps you maintain the level in a healthy range by checking four times a day, especially when you are required take insulin. Using a glucose monitor to monitor the blood sugar level can be part of the insulin treatment. With the equipment, fewer fingersticks are required for checking the blood sugar level.

A monitoring tool will help to show the blood sugar fluctuation patterns throughout the day. The doctor may suggest you to do blood sugar monitoring every day along with receiving A1C testing as this kind of test shows a clearer picture of your treatment plan for diabetes. According to the American Diabetes Association, you should keep your A1C level under 7% if you are already receiving a diabetes treatment.

However, your doctor may set a different A1C level target based on your age, the drugs you are taking, and the effects of hypoglycemia on you, among other factors.

Insulin: important for treatment of type 1, type 2 and gestational diabetes. One difference among them is that, unlike type 2 and gestational diabetes, patients with type 1 diabetes may be in a life-threatening situation if they do not receive insulin injection.

Insulin is mostly delivered to a patient’s body by injections with a small needle and syringe. For those feeling uncomfortable with the needle, some other options are available. These include an insulin pen and an insulin pump.An insulin formula may include short-acting (regular insulin), rapid-acting insulin, long-acting insulin or intermediate options.

Insulin pump: a device that is to be worn outside the body to let a catheter be inserted into the abdominal skin. Insulin will be delivered into the body from a tube that is connected to this catheter. Insulin pump will deliver constant amounts of insulin throughout the day. And when you eat food, that will trigger the insulin pump to gradually deliver specific amounts of insulin.

Continuous glucose monitor: used for those who need to monitor their blood sugar level every few minutes. A sensor is inserted into the skin to monitor the sugar level.

Wireless insulin pump: helps you to change how much insulin it pumps out based on how high the sugar level is, what kind of food you are eating and how active you have been lately.

Closed-loop insulin deliver: used for type 1 diabetes as an artificial pancreas. It has been approved by the Food and Drug Administration (FDA). In this delivery system, an insulin pump is connected to a continuous glucose monitor to keep the blood sugar levels monitored every five minutes. With the constant monitoring, the pump will give a proper amount of insulin after receiving a signal from the monitor.

Oral or other drugs: oral or injected drugs which have different effects to control diabetes including triggering the pancreas to release more insulin, and making the liver produce or release less glucose so that less insulin is needed to move sugar into cells.Diabetes drugs include the primary drug prescribed for type 2 diabetes called Metformin, and another class of medication called SGLT2 inhibitors. These medications disrupt the reabsorption of filtered blood sugar in the kidneys. This will allow the body to get rid of the sugar through urination.

Transplantation: A pancreas transplant is a high-risk procedure with many limitations. Those who have a pancreas transplant must take immunosuppressive drugs for the rest of their lives to prevent organ rejection. These drugs can have serious side effects.Due to these disadvantages, a pancreas transplant is recommended only for those with uncontrolled diabetes or the need to undergo a kidney transplant. One benefit of a successful pancreas transplant is that insulin therapy will not be required anymore.

Bariatric surgery: or gastric bypass, is recommended for those who have type 2 diabetes with obesity and body mass index over 35. It will significantly improve one’s blood sugar levels.

Treatment for gestational diabetes

A treatment plan for gestational diabetes may include eating healthy food, frequent exercises, monitoring blood sugar levels, as well as using insulin or oral medications.
A successful treatment to stabilize the blood sugar is essential for lowering the chance of having delivery complications and preventing danger to a baby in the womb. Doctor will monitor mother’s blood sugar level during labor. While delivering a child, if mother has high blood sugar level, the baby may release high amounts of insulin and cause low blood sugar level after birth.

Treatment for prediabetes

A primary goal for those with prediabetes is to prevent the disease from progressing into type 2 diabetes by keeping the blood sugar in the normal range.

This can be done in many ways, including maintain healthy weight, eating healthy food and exercising among other healthy habits.

Problems in any type of diabetes

Hyperglycemia (high blood sugar)

Many factors can cause an abnormally high level of blood sugar, including overeating, sickness and not taking diabetes medications as guided by the doctor.

Hyperglycemia can cause many symptoms, including:

• Frequent urination
• Excessive thirst
• Blurred vision
• Loss of energy
• Headache
• Irritability

Hyperglycemia may be a sign that you need to change your eating habits and/or the drugs you are taking.

Diabetic ketoacidosis (Increased ketones in urine)

Ketones, which are toxic acids, may be released into the bloodstream as a result of fat breakdown after cells cannot receive enough energy.

Ketones in bloodstream may cause any of the following symptoms:

• Nausea and vomiting
• Pain in the abdomen
• Breath that smells sweet and fruity
• Breathing difficulties
• Dry mouth
• Loss of energy
• Confusion
• Coma

Hyperglycemic hyperosmolar nonketotic syndrome

Hyperosmolar syndrome occurs when there is too much sugar in the bloodstream and causes blood to be thick and syrupy.

Hyperosmolar syndrome occurs in people with type 2 diabetes, especially after an illness.

This disorder can cause fatal symptoms, such as:

• Blood sugar level over 600 mg/dL (33.3 mmol/L)
• Dry mouth
• Feeling thirsty all the time
• Fever
• Drowsiness
• Confusion
• Loss of vision
• Hallucinations

Emergency care is required if you have any of these symptoms.

Hypoglycemia (low blood sugar)

Hypoglycemia occurs when your blood sugar level has become too low from fasting, exercising harder than normal and taking too much substances that lower the sugar level, such as insulin and diabetes medications.

When your blood sugar level becomes too low, it may cause any of these symptoms:

• Sweating
• Trembling
• Loss of energy
• Hunger
• Feeling lightheaded
• Headache
• Blurred vision
• Irregular heart rhythms
• Irritability
• Speaking difficulties
• Drowsiness
• Confusion
• Falling unconscious
• Seizure

Doctors who treat this condition