Diabetes

Diabetes mellitus, or diabetes, refers to a group of diseases that affect how your body uses blood glucose, commonly called blood sugar. Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain's main source of fuel.

Depending on what type of diabetes you have, blood sugar monitoring, insulin and oral medicines may play a role in your treatment. But no matter what type of diabetes you have, eating a healthy diet, maintaining a healthy weight and watching your blood sugar levels are key to managing your diabetes.

We are here to help you learn more about diabetes:

Diabetes mellitus, or diabetes, refers to a group of diseases that affect how your body uses blood glucose, commonly called blood sugar. Glucose is vital to your health because it’s an important source of energy for the cells that make up your muscles and tissues. It’s also your brain’s main source of fuel.

Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Prediabetes is a condition in which your blood sugar levels are higher than normal, but not high enough to be classified as diabetes and may be reversible. Gestational diabetes occurs during pregnancy but may resolve after the baby is delivered.

If you have diabetes, no matter what type, it means you have too much glucose in your blood. Too much glucose can lead to serious health problems.

There are several ways to diagnose diabetes. Each method usually requires that your tests be done twice to ensure that you have diabetes. If your doctor determines that your blood glucose level is very high, or if you have symptoms of high blood glucose and your glucose test is high, you may not need to have a second test to diagnose diabetes.

Testing should be carried out in a health care setting (such as a doctor’s office or lab). Tests to diagnose diabetes include:

A1C: The A1C test measures your average blood glucose for the past two to three months. This is a blood test so you will not have to fast or drink anything. Diabetes is diagnosed if the A1C is 6.5% or higher.

Fasting Plasma Glucose (FPG): This is a blood test that checks your fasting blood glucose levels. For this test, you must fast, that is not having anything to eat or drink (except water) for at least 8 hours before the test. This test is usually done first thing in the morning, before breakfast. Diabetes is diagnosed if fasting blood glucose is 126 mg/dL or higher.

Oral Glucose Tolerance Test (OGTT): The OGTT is a two-hour test that checks your blood glucose levels before, and again two hours after, you drink a special sweet drink. It tells the doctor how your body processes glucose. Diabetes is diagnosed if the two hour blood glucose test is 200 mg/dL or higher.

Random (also called Casual) Plasma Glucose Test. This test is a blood check done at any time of the day when you have severe diabetes symptoms. Diabetes is diagnosed if blood glucose is 200 mg/dL or higher.

How is Prediabetes Diagnosed?

Prediabetes is a condition where your blood glucose is higher than normal but not high enough to be diabetes. This condition puts you at risk for developing type 2 diabetes.

There are no clear symptoms of prediabetes, so it is possible to have it and not know it. Some people with prediabetes may have some symptoms of diabetes or problems associated with it. People usually find out that they have prediabetes during diabetes testing. If you have prediabetes, you should be checked for type 2 diabetes every one to two years.

Prediabetes is diagnosed if:

  • A1C is 5.7% – 6.4%.
  • Fasting blood glucose is 100 – 125 mg/dL.
  • OGTT two-hour blood glucose is 140 mg/dL – 199 mg/dL.

Diabetes symptoms vary, depending on how high the blood sugar level is. Some people, especially those with prediabetes or type 2 diabetes, may not have any symptoms initially. Symptoms of type 1 diabetes tend to come on quickly and be more severe. Some of the signs and symptoms of type 1 and type 2 diabetes include:

  • Increased thirst
  • Frequent urination
  • Extreme hunger
  • Unexplained weight loss
  • Presence of ketones (toxic acids resulting from the breakdown of muscle and fat that happens when there is not enough insulin) in the urine
  • Tiredness
  • Blurred vision
  • Slow-healing sores
  • High blood pressure
  • Frequent infections (such as gum or skin infections) and vaginal or bladder infections

    Type 1 diabetes can develop at any age, but it usually begins during childhood or adolescence. Type 2 diabetes, the more common type, can develop at any age and is often preventable.

  • If you suspect you or your child may have diabetes. If you notice any possible diabetes symptoms, call your doctor. The earlier the condition is found, the sooner treatment can begin.
  • If you’ve already been diagnosed with diabetes. Once you have been told that you have diabetes, you’ll need to see your doctor until your blood sugar levels are under control.

To understand what diabetes is, you must first understand how glucose (blood sugar) is normally processed in the body.

How Insulin Works

Insulin is a hormone that comes from the pancreas, a gland situated behind and below the stomach. The pancreas releases insulin into the bloodstream. Insulin allows sugar to enter your cells and lowers the amount of sugar that is in your bloodstream. As your blood sugar level drops, so does the amount of insulin released from your pancreas.

The Role of Glucose

Glucose is a blood sugar. It is the main source of energy for the cells that make up muscles and other tissues in the body. Glucose comes from two major sources: food and your liver. Glucose is absorbed into the bloodstream and, where it enters the cells with the help of insulin. Your liver stores and makes glucose. When your insulin levels are low, such as when you haven’t eaten in a while, the liver breaks down glycogen (which is the main form of glucose that is stored in the body) into glucose to keep your glucose level within a normal range.

Causes of Type 1 Diabetes

Your immune system normally fights harmful bacteria or viruses. In type 1 diabetes, it attacks and destroys the insulin-producing cells in the pancreas. This leaves you with little or no insulin; instead of going into your cells, sugar builds up in your bloodstream. Type 1 diabetes is thought to be caused by a combination of genetic and environmental factors. However, exactly what many of those factors are is still unclear.

Causes of Prediabetes and Type 2 Diabetes

In prediabetes and type 2 diabetes, your cells become resistant to insulin. When this happens, your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells where it’s needed for energy, sugar builds up in your bloodstream. Exactly why this happens is uncertain but it’s believed that genetic and environmental factors play a role. Being overweight is a strong risk factor for the development of type 2 diabetes.

Causes of Gestational Diabetes

During pregnancy, the placenta makes hormones you will need to carry on your pregnancy. These hormones make your cells more resistant to insulin. As your placenta grows larger in the second and third trimesters, it creates more of these hormones, making it even harder for insulin to do its job. Normally, your pancreas produces enough extra insulin to beat this resistance. But sometimes, the pancreas can’t keep up. When this happens, not enough glucose gets into the cells and too much stays in the blood. This is gestational diabetes

Risk factors for diabetes may vary based on the type of diabetes that you have.

Risk Factors for Type 1 Diabetes

Although the exact cause of type 1 diabetes is unknown, genetic factors likely play a role. Your risk of developing type 1 diabetes increases if you have a parent or sibling who has type 1 diabetes. Environmental factors, such as exposure to a viral illness, may also play a role in type 1 diabetes.

Other factors that may increase your risk include:

  • The presence of diabetes antibodies (which mistakenly target and damage cells in the body): Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes antibodies. If you have these autoantibodies, there is a higher risk of developing type 1 diabetes. But, not everyone who has these autoantibodies develops type 1 diabetes.
  • Dietary factors: A number of dietary factors have been linked to an increased risk of type 1 diabetes such as low vitamin D consumption, early exposure to cow’s milk or cow’s milk formula and exposure to cereals before four months of age. However, none of these factors have been shown to cause type 1 diabetes.
  • Race: Type 1 diabetes is more common in Caucasians (whites) than in other races.
  • Geography: Certain countries, such as Finland and Sweden, have higher rates of type 1 diabetes.

Risk Factors for Prediabetes and Type 2 Diabetes

Researchers don’t fully understand why some people develop prediabetes or type 2 diabetes and others don’t. However, it’s clear that certain factors increase the risk, including:

  • Overweight: The more fatty tissue you have, the more resistant your cells become to insulin.
  • Inactivity: The less active you are, the greater your risk. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more receptive to insulin. Exercising less than three times a week may increase your risk of type 2 diabetes.
  • Family history: Your risk increases if a parent or sibling has type 2 diabetes.
  • Race: Although it’s unclear why, people of certain races — including blacks, Hispanics, American Indians and Asians — are at higher risk.
  • Age: Risk increases as you get older; this may be because you tend to exercise less, lose muscle mass and gain weight as you age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults.
  • Gestational diabetes: If you developed gestational diabetes when you were pregnant, your risk of developing prediabetes and type 2 diabetes later increases. If you gave birth to a baby weighing more than 9 pounds, you’re also at risk of type 2 diabetes.
  • Polycystic ovary syndrome: For women, having polycystic ovary syndrome, a common condition in which women have irregular menstrual periods, excess hair growth and are overweight, increases the risk of diabetes.
  • High blood pressure: Having blood pressure over 140/90 mm Hg is linked to an increased risk of type 2 diabetes.
  • Cholesterol levels: If you have low levels of high-density lipoprotein (HDL), or "good" cholesterol, your risk of type 2 diabetes is higher. Low levels of HDL are defined as below 35 mg/dL.
  • High levels of triglycerides: Triglycerides are a fat that is carried in the blood. If your triglyceride levels are above 250 mg/dL, your risk of diabetes increases.

Risk Factors for Gestational Diabetes

Any pregnant woman can develop gestational diabetes, but some women are at greater risk than others. Risk factors for gestational diabetes include:

  • Age: Women older than age 25 are at greater risk.
  • Family or personal history: Your risk increases if you have prediabetes. Prediabetes is a condition that may lead to type 2 diabetes. If a close family member, such as a parent or sibling, has type 2 diabetes, your risk is higher. You’re also at greater risk if you had gestational diabetes during a previous pregnancy, if you delivered a very large baby or if you had an unexplained stillbirth.
  • Overweight: Being overweight before pregnancy increases your risk.
  • Race: For reasons that aren’t clear, women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes.

There are complications from diabetes that may develop over time. The longer you have diabetes and the less controlled your blood sugar, the higher the risk of other health problems. Eventually, other health problems caused by diabetes may be disabling or even life-threatening.

These problems include:

  • Cardiovascular disease: Diabetes dramatically increases your risk of developing various cardiovascular problems, including coronary artery disease (CAD) with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis).
  • Nerve damage (neuropathy): Too much sugar can injure the walls of the tiny blood vessels that feed your nerves, especially in the legs. Symptoms include tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. If this is left untreated, all feeling could be lost in the affected limbs. Damage to the nerves related to digestion can cause problems such as nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.
  • Kidney damage (nephropathy): The kidneys contain millions of tiny blood vessel clusters (which are called glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system; severe damage can lead to kidney failure or end-stage kidney disease, which may require dialysis or a kidney transplant. Serious kidney disease has dropped significantly in recent years, likely due to improvements in diabetes management.
  • Eye damage (retinopathy): Diabetes can damage the blood vessels of the retina (the light-sensitive layer of tissue at the back of the inner eye), a condition known as diabetic retinopathy. This condition may lead to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
  • Foot damage: Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot problems. Left untreated, cuts and blisters can develop into serious infections. Severe damage might require toe, foot or even leg amputation.
  • Skin and mouth conditions: Diabetes may make you more likely to have skin problems, including bacterial and fungal infections. Gum infections may also be a concern, especially if you have a history of poor dental care.
  • Osteoporosis: Diabetes may lead to lower than normal bone mineral density (bone mass), increasing your risk of osteoporosis, a disease that can lead to bone fractures.
  • Alzheimer’s disease: Type 2 diabetes may increase the risk of Alzheimer’s disease. The less your blood sugar is controlled, the greater the risk appears to be. Heart and blood problems caused by diabetes may contribute to dementia by blocking blood flow to the brain or causing strokes. Too much insulin in the blood may lead to brain-damaging inflammation, or the brain cells may not get enough glucose due to blocked blood flow.
  • Cancer: People with diabetes have a higher risk of some cancers. But the reasons aren’t clear; it may be that the factors that increase the risk of type 2 diabetes also increase the risk of cancer or it may be a factor of the disease or its treatment. There is much research in this area, but in the meantime, no changes in treatment are recommended.

Health Problems Caused by Gestational Diabetes

Most women who have gestational diabetes deliver healthy babies. However, if it is untreated or uncontrolled, blood sugar levels can cause problems for you and your baby.

The following health problems can affect your baby:

  • Excess growth: Extra glucose can go to the placenta, which causes your baby’s pancreas to make extra insulin. This can cause your baby to grow too large (a condition called macrosomia). Very large babies are more likely to require a C-section delivery.
  • Low blood sugar: Sometimes babies of mothers with gestational diabetes develop low blood sugar (a condition called hypoglycemia) shortly after birth because their own insulin production is so high. Timely feedings, and sometimes an intravenous (IV) glucose solution, can return the baby’s blood sugar level to normal.
  • Respiratory distress syndrome: If your baby is delivered early, respiratory distress syndrome, a condition that makes it hard to breathe, is possible. Babies who have this syndrome may need help breathing until their lungs become stronger.
  • Jaundice: This yellowish coloring of the skin and the whites of the eyes may occur if a baby’s liver isn’t mature enough to break down a substance called bilirubin, which normally forms when the body recycles old or damaged red blood cells. Although jaundice usually isn’t a cause for concern, careful monitoring is important.
  • Type 2 diabetes later in life: Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
  • Death: Untreated gestational diabetes can result in a baby’s death either before or shortly after birth.

    The following health problems can affect you:

    • Preeclampsia: Women with this condition have high blood pressure, extra protein in the urine and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby.
    • Gestational diabetes in later pregnancies: Once you’ve had gestational diabetes in one pregnancy, you’re more likely to have it again with the next pregnancy. You’re also more likely to develop diabetes, typically type 2 diabetes, as you get older.

Health Problems Caused by Prediabetes

Type 2 Diabetes: Prediabetes may develop into type 2 diabetes.

Guidelines for Diabetes Testing

Symptoms of type 1 diabetes often appear suddenly and are often the reason for checking blood sugar levels. However, because there may not be any symptoms of the other types of diabetes and prediabetes or because they may come on more gradually, the American Diabetes Association (ADA) has recommended the following screening guidelines:

Anyone with a body mass index (BMI) higher than 25, regardless of age, who has the following risk factors, should be screened:

  • High blood pressure
  • An inactive lifestyle
  • A history of polycystic ovary syndrome
  • Delivered a baby who weighed more than 9 pounds
  • A history of diabetes in pregnancy
  • High cholesterol levels
  • A history of heart disease
  • A close relative with diabetes.

Anyone older than age 45 is advised to have an initial blood sugar screening, and if the results are normal, they should be screened every three years thereafter.

 fat tissue are used for energy if your body doesn’t have enough insulin to use the available glucose.

Sometimes, a blood test called a C peptide level test, which measures the ability of your pancreas to secrete insulin, may be done as well. Levels of C peptide are usually low in people with type 1 diabetes, but may be normal or high in people with type 2 diabetes.

Guidelines and Tests for Gestational Diabetes

There is not a single set of screening guidelines for gestational diabetes. Therefore, your doctor will likely evaluate your risk factors for gestational diabetes early in your pregnancy.

  • If you’re at high risk of gestational diabetes, for example, your body mass index (BMI) before pregnancy was 30 or higher, you had gestational diabetes during a previous pregnancy or you have a mother, father, sibling or child with diabetes, your doctor may test for diabetes at your first pregnancy office visit.

  • If you’re at average risk of gestational diabetes, you’ll likely have a screening test for gestational diabetes sometime during your second trimester, typically between 24 and 28 weeks of pregnancy.

    Your doctor may use the following screening tests:

    • Initial glucose challenge test: You’ll begin the glucose challenge test by drinking a syrupy glucose solution. One hour later, you’ll have a blood test to measure your blood sugar level. A blood sugar level that is below 130 to 140 mg/dL or 7.2 to 7.8 mmol/L is usually considered normal on a glucose challenge test, although this may vary at specific clinics or labs. If your blood sugar level is higher than normal, it only means that you have a higher risk of gestational diabetes. Your doctor will order another test to determine if you have gestational diabetes.

    • Follow-up glucose tolerance testing: For this test, you’ll be asked to fast overnight and then have your fasting blood sugar level measured. Then you’ll drink another sweet solution, this one containing a higher concentration of glucose, and your blood sugar level will be checked every hour for a period of three hours. If at least two of the blood sugar readings are higher than normal, you’ll be diagnosed with gestational diabetes.

Tests for Prediabetes

  • The glycated hemoglobin (A1C) test: This blood test gives your average blood sugar level for the past two to three months. It works by measuring the percentage of blood sugar that is attached to hemoglobin (the oxygen-carrying protein in red blood cells). The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached. An A1C level between 5.7 and 6.4 percent suggests you have prediabetes while normal levels are below 5.7 percent.

    If the A1C test isn’t available or if you have certain conditions that can make the A1C test inaccurate — such as if you’re pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — your doctor may use the following tests to find out if you have diabetes:

  • Fasting blood sugar test: A blood sample will be taken after an overnight fast. A blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. Normal is below 100 mg/dL.

  • Oral glucose tolerance test: A blood sample will be taken after you fast for at least eight hours or overnight. Then you’ll drink a sugary solution, and your blood sugar level will be measured again after two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A blood sugar level from 140 to 199 mg/dL (7.8 to 11 mmol/L) is considered prediabetes.

Depending on what type of diabetes you have, blood sugar monitoring, insulin and oral medicines may play a role in your treatment. But no matter what type of diabetes you have, eating a healthy diet, exercising on a regular basis, maintaining a healthy weight and watching your blood sugar levels are very important to managing your diabetes.

Treatments for All Types of Diabetes

Maintain a Healthy Weight Through a Healthy Diet and Exercise Plan

  • Healthy eating: There is no specific diet for diabetes. To manage your diabetes, your diet will need to include more fruits, vegetables, whole grains and proteins – foods that are high in nutrition and fiber and low in fat and calories — and cut down on high fat animal products, refined carbohydrates (examples are chips, crackers and white bread) and sweets. In fact, this eating plan is great for the entire family. Sugary foods are OK once in a while, as long as they’re included in a balanced meal plan.

    Understanding what to eat, how much to eat and the healthiest ways to prepare your meals can be a challenge. A registered dietitian can help you create a meal plan that fits your health goals, food likes and dislikes and lifestyle. As part of your plan, you may have to count the amount of carbohydrates that you eat, especially if you have type 1 diabetes.

  • Physical activity: Everyone, including people with diabetes, needs regular aerobic exercise (examples are stair climbing, walking and swimming). Exercise helps to lower your blood sugar level by carrying sugar to your cells, where it’s used for energy. It also increases your body’s sensitivity to insulin, which means you need less insulin to carry sugar to your cells.

    Always check with your doctor to make sure you are healthy enough to exercise before you start a regular exercise program. Then choose activities you enjoy such as walking, swimming or biking. It’s important to make physical activity part of your daily routine. Aim for at least 30 minutes or more of aerobic exercise most days of the week. If you haven’t been active for a while, start slowly and build up gradually.

Treatments for Type 1 and Type 2 Diabetes

The treatment for type 1 diabetes can include insulin injections or the use of an insulin pump, frequent blood sugar checks and carbohydrate counting. Treatment of type 2 diabetes primarily includes blood sugar monitoring, along with daily medicines and/or insulin.

  • Monitoring your blood sugar: Depending on your treatment plan, you may need to check and record your blood sugar level several times a week, or you might need to check it three or more times a day. Careful monitoring is the only way to make sure that your blood sugar levels remain stable. People who receive insulin may also choose to monitor their blood sugar level with a continuous glucose monitor device. Although this technology doesn’t replace the glucose meter, it can provide important information about your blood sugar levels that your doctor can use.

    Even if you eat on a strict schedule, the amount of sugar in your blood can change unpredictably. With help from your diabetes treatment team, you’ll learn how your blood sugar level changes due to food, physical activity, medicines, illness, alcohol, stress and, for women, changes in hormone levels.

    Your doctor may also recommend regular A1C testing, a blood test that measures your average blood sugar level for the past two to three months. Compared with daily blood sugar tests, A1C testing helps your doctor know how well your diabetes treatment plan is working. An elevated A1C level may mean you need a change in your insulin dosage or meal plan. Your A1C test results may vary depending on your age and other factors. However, for most people with diabetes, the American Diabetes Association recommends an A1C of below 7 percent. Ask your doctor what your A1C should be.

  • Insulin: Most people with type 1 diabetes need to take insulin (known as insulin therapy) to survive. Some people with type 2 diabetes also need insulin therapy. Often, insulin is taken as a shot using a very thin needle and syringe or an insulin pen (a device that looks like an ink pen, except the cartridge is filled with insulin).

    An insulin pump may also be an option. The pump is a device about the size of a cellphone worn on the outside of your body. The pump is connected to a tube that’s inserted under the skin of your abdomen. A tubeless pump that works wirelessly is also now available. The insulin pump is programmed by your doctor to give out specific amounts of insulin. It can be adjusted to deliver more or less insulin depending on meals, your activity level and blood sugar level.

    A new treatment is called the closed loop insulin delivery, also known as the artificial pancreas. It links a continuous glucose monitor to an insulin pump. The device automatically delivers the correct amount of insulin when the monitor indicates that your body needs it. Testing has shown positive results, but more research is still needed.

    Many types of insulin are available, including rapid-acting insulin, long-acting insulin and intermediate options. Depending on your needs, your doctor may prescribe a mix of insulin types throughout the day and night.

  • Oral or other medicines: Sometimes other oral or injected medicines are prescribed as well. Some diabetes medicines get your pancreas to produce and release more insulin. Others stop or slow down the production and release of glucose from your liver, which means you need less insulin to bring sugar into your cells. Still others block the action of stomach or intestinal enzymes that break down carbohydrates or make your tissues more sensitive to insulin.

  • Transplants: In some people who have type 1 diabetes, a pancreas transplant may be an option. Islet (cells in the pancreas that produce insulin) transplants are being studied as well. With a successful pancreas transplant, you would no longer need insulin therapy. But transplants aren’t always successful and these procedures pose serious risks; immune-suppressing drugs are needed on a daily basis to prevent organ rejection. These drugs can have serious side effects, including a high risk of infection, organ injury and cancer. Because the side effects can be more dangerous than the diabetes, transplants are usually reserved for people whose diabetes can’t be controlled or those who have other serious health problems due to their diabetes.
  • Bariatric surgery (weight loss surgery): Although it is not considered a treatment for type 2 diabetes, people with type 2 diabetes who also have a body mass index (BMI) higher than 35 may benefit from this type of surgery. People who’ve undergone gastric bypass have seen significant improvements in their blood sugar levels. However, this procedure’s long-term risks and benefits for type 2 diabetes aren’t yet known.

Treatments for Gestational Diabetes

Controlling your blood sugar level is very important as it will help keep your baby healthy and avoid problems during delivery. In addition to eating a healthy diet and exercising, your treatment plan may include monitoring your blood sugar and, in some cases, using insulin or other medicines.

Your health care provider will also monitor your blood sugar level during labor. If your blood sugar rises, your baby may release high levels of insulin, which can lead to low blood sugar right after birth.

Treatments for Prediabetes

If you have prediabetes, healthy lifestyle choices can help bring your blood sugar level back to normal or at least keep it from rising too high. Maintaining a healthy weight through regular exercise and healthy eating habits can help. Exercising at least 2 1/2 hours a week and losing 5 to 10 percent of your body weight may prevent or delay type 2 diabetes.

Sometimes medicines such as metformin (e.g., Glucophage, Glumetza and others) may be an option if you’re at high risk of diabetes. Your doctor may prescribe medicine when your prediabetes is getting worse or if you have cardiovascular disease, fatty liver disease or polycystic ovary syndrome.

Your doctor may also prescribe medicines to control cholesterol, such as statins, and high blood pressure medicines if they are needed. Your doctor might prescribe low-dose aspirin therapy to help prevent heart disease if you’re at high risk. However, healthy lifestyle choices remain the best treatment for prediabetes.

Because so many factors can affect your blood sugar, problems sometimes arise. These conditions require immediate care because if they are left untreated, seizures and loss of consciousness (coma) can occur.

  • High blood sugar (hyperglycemia): Your blood sugar level can rise for many reasons, including eating too much, being sick or not taking enough diabetes medicine. Check your blood sugar level often and watch for signs and symptoms of high blood sugar including frequent urination, increased thirst, dry mouth, blurred vision, fatigue and nausea. If you have hyperglycemia, you’ll need to adjust your meal plan and/or medicines.
  • Increased ketones in your urine (diabetic ketoacidosis): If your cells are starved for energy, your body may begin to break down fat. This produces toxic acids known as ketones. Watch for loss of appetite, weakness, vomiting, fever, stomach pain and a sweet, fruity breath. You can check your urine for excess ketones with an over-the-counter ketones test kit. If you have excess ketones in your urine, call your doctor right away or seek emergency care. This condition is more common in people with type 1 diabetes.
  • Hyperglycemic hyperosmolar nonketotic syndrome: Signs and symptoms of this life-threatening condition include a blood sugar reading over 600 mg/dL (33.3 mmol/L), dry mouth, extreme thirst, fever, drowsiness, confusion, vision loss and hallucinations. Hyperosmolar syndrome is caused by very high blood sugar that turns blood thick and syrupy. It tends to be more common in people with type 2 diabetes and it often follows an illness. Call your doctor or seek immediate medical care if you have signs or symptoms of this condition.
  • Low blood sugar (hypoglycemia): If your blood sugar level drops below what it should be, it’s known as low blood sugar. Your blood sugar level can drop for many reasons, including skipping a meal and more physical activity than normal. However, low blood sugar is most likely to occur if you take diabetes medicines that promote insulin production or if you’re receiving insulin therapy. It’s very important to check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar including sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations (flutters), feelings of anger, slurred speech, being tired, confusion, fainting and seizures. Low blood sugar is treated with carbohydrates that are quickly taken in by the body, such as fruit juice or glucose pills.

Diabetes is a serious disease. You must commit to following your diabetes treatment plan 24 hours a day, seven days a week. Careful management of diabetes can lower your risk of serious, and even life-threatening, health problems.

All Types of Diabetes:

  • Commit to managing your diabetes: Learn all you can about your condition. Meet with a diabetes educator and ask your diabetes health care team for help when you need it.
  • Choose healthy foods and maintain a healthy weight: If you are overweight, losing just 5 to 10 percent of your body weight can make a big difference in your blood sugar control. A healthy diet is one with plenty of fruits, vegetables, whole grains, beans and healthy proteins, with a limited amount of saturated fat.
  • Make physical activity part of your daily routine: Regular exercise can help prevent prediabetes and type 2 diabetes, and it can help those who already have diabetes to maintain better blood sugar control. Thirty minutes of moderate exercise such as brisk walking most days, is recommended. A recent study found that a combination of aerobic exercises (such as walking or dancing) combined with resistance training (such as weightlifting or yoga) helps control blood sugar better than either type of exercise alone.

Lifestyle Changes for Type 1 and Type 2 Diabetes

There are some lifestyle changes that you can make to help type 1 or type 2 diabetes:

  • Identify yourself: Wear a tag or bracelet that lets others know that you have diabetes.
  • Keep a glucagon kit: Keep a glucagon (a hormone that raises blood glucose levels) injection kit nearby in case of a severe low blood sugar emergency and make sure your friends and loved ones know how to use it.
  • Schedule a yearly physical and regular eye exams. Your regular diabetes checkups aren’t meant to replace yearly physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications and screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma.
  • Keep your shots up to date. High blood sugar can weaken your immune system. Get a flu shot every year and get a tetanus booster shot every 10 years. Your doctor will likely recommend the pneumonia shot as well. The Centers for Disease Control and Prevention (CDC) also recommends hepatitis B vaccination if you haven’t previously had a hepatitis B shot and you’re between the ages of 19 to 59 with type 1 or type 2 diabetes. The most recent CDC guidelines advise getting all needed vaccines as soon as possible after being diagnosed with type 1 or type 2 diabetes. If you are age 60 or older, have diabetes and are not up-to-date on your vaccines, talk to your doctor about whether you should get them.
  • Pay attention to your feet: Wash your feet daily in warm water. Dry them gently, especially between the toes. Moisturize with lotion, but not between the toes. Check your feet every day for blisters, cuts, sores, redness or swelling. Call your doctor if you have a sore or other foot problem that doesn’t start to heal on its own or if you notice anything unusual.
  • Keep your blood pressure and cholesterol under control: Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Medicine may also be needed. Talk to your doctor about your blood pressure and cholesterol.
  • Take care of your teeth: Diabetes may make you more likely to get gum infections. Brush and floss your teeth at least twice a day. And if you have type 1 or type 2 diabetes, schedule a dental exam at least once a year. Call your dentist right away if your gums bleed or look red or swollen.
  • If you smoke or use other types of tobacco, we can help you quit. Smoking increases your risk of having other health problems because of your diabetes. Heart attack, stroke, nerve damage and kidney disease can occur. Smokers who have diabetes are more likely to die of heart disease than are nonsmokers who have diabetes, according to the American Diabetes Association. Talk to your doctor about ways to stop smoking or using other types of tobacco. We can also help you quit through our Tobacco Free PATH program.
  • If you drink alcohol, be responsible: Alcohol can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time. If you choose to drink, limit it to one drink a day for women, two drinks a day for men and always make sure to eat if you drink alcohol. Also, remember to add the carbohydrates from any alcohol you drink to your daily carbohydrate count.
  • Take stress seriously: If you’re stressed, it’s easy to stop following your usual diabetes management plan. The hormones your body makes when you are under stress can stop insulin from working properly, which can make your sugar level even worse. To take control of stress, set limits, prioritize your tasks, learn relaxation techniques and get plenty of sleep.

Above all, stay positive and committed to your diabetes management plan. The good habits you adopt today can help you enjoy an active, healthy life with diabetes.

Living with diabetes can be hard and frustrating. Sometimes, even when you’ve done everything right, your blood sugar levels may rise. But, if you stick with your diabetes management plan, you will likely see a positive difference in your sugar levels when you visit your doctor.

Because good diabetes management can take up a lot of time and feel overwhelming, some people find it helpful to talk to a mental health professional or others with the condition. Sharing your frustrations and your successes with people who understand what you’re going through can be very useful. And you may find that others have great tips to share about diabetes management.

Your doctor can recommend a mental health professional for you to speak with and may know of a local support group as well. You can also call EmblemHealth Customer Service at the phone number listed on the back of your member ID card or use our Find A Doctor tool to locate a professional in your area.

Type 1 diabetes can’t be prevented. However, the same healthy lifestyle choices that help treat prediabetes, type 2 diabetes and gestational diabetes can help prevent them.

  • Eat healthy foods: Choose foods low in fat and calories. Focus on fruits, vegetables, whole grains and low fat protein. Look for a variety of foods to prevent boredom.

  • Get more physical activity: Aim for 30 minutes of moderate physical activity each day. Take a brisk walk, ride your bike or swim laps. If you can’t fit in a long workout, break it up into smaller sessions spread throughout the day.

  • Lose excess pounds: If you’re overweight, losing even 5 percent of your body weight, for example, 10 pounds if you weigh 200 pounds, can reduce the risk of diabetes. To keep your weight in a healthy range, focus on making long-lasting changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight such as a healthier heart, more energy and improved self-esteem.

    Sometimes medicine is an option as well. Oral diabetes drugs such as metformin (e.g. Glucophage, Glumetza and others) may reduce your chances of developing type 2 diabetes. However, healthy lifestyle choices remain the best way to prevent type 2 diabetes.

If you are having diabetes symptoms, see your primary care doctor. If your child is having diabetes symptoms, you might see your child’s pediatrician. If your doctor finds that blood sugar levels are extremely high, you’ll likely be sent to the emergency room. If blood sugar levels aren’t high enough to put you or your child immediately at risk you may be referred to an endocrinologist, a doctor who specializes in diabetes among other disorders.

What Can You Do to Get Ready for Your Appointment?

  • Be aware of anything you can’t eat or drink before your doctor appointment: When you make the appointment, ask if there’s anything you need to do before your doctor visit. You may need to limit your diet for certain tests.
  • Write down any symptoms you are having: Include symptoms that you find unusual or may seem unrelated to your current health concerns.
  • Write down important personal information: Include major stresses that you are having or recent life changes. If you’re checking your blood sugar at home, bring a record of the results (which should include the dates and times of testing) so that you can share this with your doctor.
  • Make a list of any allergies you have and all medicines, vitamins and supplements you’re currently taking.
  • Record your family medical history: In particular, note any relatives who have had diabetes, heart attacks or strokes.
  • Take a family member or friend with you to your next office visit: If possible, bring someone with you to help you remember things to tell the doctor and help you recall information and instructions from the doctor.
  • It’s important to tell your doctor if you need any prescription refills: Your doctor can renew your prescriptions while you’re there.
  • Write down any questions that you want to ask your doctor: Ask questions about anything you are not clear about or concerns you have.

Your List of Questions for the Doctor

Preparing a list of questions can help you make the most of your time with your doctor. For diabetes, some questions to ask include:

  • Are the symptoms I’m having related to my diabetes or another condition?
  • What tests do I need to best manage my diabetes?
  • What else can I do to take care of my health?
  • What are other ways I can manage my diabetes?
  • I have other health conditions. How can I best manage these conditions along with diabetes?
  • Are there things I must limit or stay away from?
  • Should I see another specialist, such as a dietitian or diabetes educator?
  • Is there a generic option for the medicine you are prescribing?
  • Are there brochures or other educational material I can take with me? What websites do you recommend I visit to learn more?

    Also make sure to ask any other questions you have.

What Can You Expect from Your Doctor During Your Appointment?

Your doctor is likely to ask you a number of questions, such as:

  • When did you begin being concerned about having diabetes? What symptoms are you having?
  • Do you have your symptoms all the time or only from time-to-time?
  • How bad are your symptoms?
  • Do you have a family history of preeclampsia or diabetes?
  • What do you typically eat?
  • Do you exercise? If so, what type of exercises do you do and how often?
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