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Disease of the Day: Diabetes

Category

This is an Endocrine; nutritional and metabolic Disease

Synonym Name

Type 2 diabetes

Overview

 
Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose). 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.If you have diabetes, no matter what type, it means you have too much glucose in your blood, although the causes may differ. Too much glucose can lead to serious health problems.Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes — when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes — and gestational diabetes, which occurs during pregnancy but may resolve after the baby is delivered.

Risks

For some people, a deviated septum is present at birth — occurring during fetal development or due to injury during childbirth. After birth, a deviated septum is most commonly caused by an injury that moves your nasal septum out of place. Risk factors include:
 
  • Risk factors for diabetes depend on the type of 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, also likely play some role in type 1 diabetes. Other factors that may increase your risk include:
 
  • Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes autoantibodies: If you have these autoantibodies, you have an increased risk of developing type 1 diabetes. But, not everyone who has these autoantibodies develops type 1
  • 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; or exposure to cereals before 4 months of age: However, none of these factors has been shown to cause type 1 diabetes
  • Type 1 diabetes is more common in whites than in other races
  • Certain countries, such as Finland and Sweden, have higher rates of type 1 diabetes
Any pregnant woman can develop gestational diabetes, but some women are at greater risk than are others. Risk factors for gestational diabetes include:
 
  • Women older than age 25 are at increased risk
  • Your risk increases if you have prediabetes — a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes: 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
  • Being overweight before pregnancy increases your risk
  • For reasons that aren't clear, women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes
Researchers don't fully understand why some people develop prediabetes and type 2 diabetes and others don't. It's clear that certain factors increase the risk, however, including:
 
  • The more fatty tissue you have, the more resistant your cells become to insulin
  • 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 sensitive to insulin. Exercising less than three times a week may increase your risk of type 2 diabetes
  • Your risk increases if a parent or sibling has type 2 diabetes
  • Although it's unclear why, people of certain races — including blacks, Hispanics, American Indians and Asians — are at higher risk
  • Your 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
  • 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 (4 kilograms), you're also at risk of type 2 diabetes
  • For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes
  • Having blood pressure over 140/90mm Hg is linked to an increased risk of type 2 diabetes
  • 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
  • Triglycerides are a fat carried in the blood: If your triglyceride levels are above 250 mg/dL, your risk of diabetes increases
Researchers don't fully understand why some people develop type 2 diabetes and others don't. It's clear, however, that certain factors increase the risk, including:
 
  • Being overweight is a primary risk factor for type 2 diabetes: The more fatty tissue you have, the more resistant your cells become to insulin
  • If your body stores fat primarily in your abdomen, your risk of type 2 diabetes is greater than if your body stores fat elsewhere, such as your hips and thighs
  • The less active you are, the greater your risk of type 2 diabetes: Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin
  • The risk of type 2 diabetes increases if your parent or sibling has type 2 diabetes
  • Although it's unclear why, people of certain races — including blacks, Hispanics, American Indians and Asian-Americans — are more likely to develop type 2 diabetes than whites are
  • The risk of type 2 diabetes increases as you get older, especially after age 45: That's probably because people tend to exercise less, lose muscle mass and gain weight as they age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults
  • Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as diabetes: Left untreated, prediabetes often progresses to type 2 diabetes
  • If you developed gestational diabetes when you were pregnant, your risk of later developing type 2 diabetes increases: If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you're also at risk of type 2 diabetes
  • Being overweight is a primary risk factor for type 2 diabetes in children: The more fatty tissue a child has, the more resistant his or her cells become to insulin. However, weight isn't the only factor in developing type 2 diabetes
  • The less active your child is, the greater his or her risk of type 2 diabetes: Physical activity helps your child control his or her weight, uses glucose as energy, and makes your child's cells more responsive to insulin
  • The risk of type 2 diabetes significantly increases if a parent or sibling has type 2 diabetes — but it's difficult to tell if this is related to lifestyle, genetics or both
  • Although it's unclear why, children of certain races — especially blacks, Hispanics, Native Americans, Asian-Americans and Pacific Islanders — are more likely to develop type 2 diabetes
Researchers don't fully understand why some children develop type 2 diabetes and others don't, even if they have similar risk factors. However, it's clear that certain factors increase the risk, including:
 
  • Being overweight is a primary risk factor for type 2 diabetes in children: The more fatty tissue a child has, the more resistant his or her cells become to insulin. However, weight isn't the only factor in developing type 2 diabetes
  • The less active your child is, the greater his or her risk of type 2 diabetes: Physical activity helps your child control his or her weight, uses glucose as energy, and makes your child's cells more responsive to insulin
  • The risk of type 2 diabetes significantly increases if a parent or sibling has type 2 diabetes — but it's difficult to tell if this is related to lifestyle, genetics or both
  • Although it's unclear why, children of certain races — especially blacks, Hispanics, Native Americans, Asian-Americans and Pacific Islanders — are more likely to develop type 2 diabetes

Causes

 
  • To understand diabetes, first you must understand how glucose is normally processed in the body
  • When your insulin levels are low, such as when you haven't eaten in a while, the liver metabolizes stored glycogen into glucose to keep your glucose level within a normal range
  • Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas stops producing enough insulin: Exactly why this happens is unknown, although excess weight and inactivity seem to be contributing factors
  • When your insulin levels are low, such as when you haven't eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range
  • In type 2 diabetes, this process works improperly: Instead of moving into your cells, sugar builds up in your bloodstream
  • In the much less common type 1 diabetes, the pancreas produces little or no insulin
  • Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas stops producing enough insulin: Exactly why this happens is unknown, although excess weight, inactivity and genetic factors seem to be important
  • In type 2 diabetes, this process doesn't work well: Instead of moving into your child's cells, sugar builds up in his or her bloodstream. This occurs when your child's pancreas doesn't make enough insulin or your child's cells become resistant to the action of insulin
How insulin works
 
  • Insulin is a hormone that comes from the pancreas, a gland situated behind and below the stomach
  • The pancreas secretes insulin into the bloodstream
  • The insulin circulates, enabling sugar to enter your cells
  • Insulin lowers the amount of sugar in your bloodstream
  • As your blood sugar level drops, so does the secretion of insulin from your pancreas
The role of glucose
 
  • Glucose — a sugar — is a main source of energy for the cells that make up muscles and other tissues
  • Glucose comes from two major sources: food and your liver
  • Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin
  • Your liver stores and makes glucose
Insulin: The key for sugar
 
  • Insulin is a hormone that comes from the pancreas, a gland located just behind the stomach: When your child eats, the pancreas secretes insulin into the bloodstream. As insulin circulates, it acts like a key by unlocking microscopic doors that allow sugar to enter your child's cells. Insulin lowers the amount of sugar in your child's bloodstream. As your child's blood sugar level drops, so does the secretion of insulin from the pancreas
Glucose: The energy source
 
  • Glucose — sugar — is a main source of energy for the cells that make up muscles and other tissues: Glucose comes from two major sources: the food your child eats and your child's liver. During digestion, sugar is absorbed into the bloodstream. Normally, sugar then enters cells with the help of insulin
Liver: Production and storage
 
  • The liver acts as a glucose storage and manufacturing center: When your child's insulin levels are low — when your child hasn't eaten in a while, for example — the liver releases the stored glucose to keep your child's glucose level within a normal range
Causes of type 1 diabetes
 
  • In type 1 diabetes, your immune system — which normally fights harmful bacteria or viruses — attacks and destroys your insulin-producing cells in the pancreas: This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream. Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what many of those factors are is still unclear
Causes of prediabetes and type 2 diabetes
 
  • In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, your cells become resistant to the action of insulin, and 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, although as in type 1 diabetes, it's believed that genetic and environmental factors play a role in the development of type 2. Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight
Causes of gestational diabetes
 
  • During pregnancy, the placenta produces hormones to sustain your pregnancy: These hormones make your cells more resistant to insulin. As your placenta grows larger in the second and third trimesters, it secretes more of these hormones — making it even harder for insulin to do its job
  • Normally, your pancreas responds by producing enough extra insulin to overcome this resistance: But sometimes your pancreas can't keep up. When this happens, too little glucose gets into your cells and too much stays in your blood. This is gestational diabetes

Symptoms

 
  • Although type 1 diabetes can develop at any age, it typically appears during childhood or adolescence: Type 2 diabetes, the more common type, can develop at any age, though it's more common in people older than 40
Some of the signs and symptoms of type 1 and type 2 diabetes are:
 
  • Blurred Vision
  • Fatigue
  • Frequent Urination
  • Increased Thirst
  • Irritability
  • Unexplained Weight Loss
  • Extreme hunger
  • Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available insulin)
  • Slow-healing sores
  • Frequent infections, such as gums or skin infections and vaginal infections
Increased thirst and frequent urination
 
  • Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues: This may leave you thirsty. As a result, you may drink — and urinate — more than usual
Weight loss
 
  • Despite eating more than usual to relieve hunger, you may lose weight: Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine
Fatigue
 
  •  If your cells are deprived of sugar, you may become tired and irritable
Blurred vision
 
  • If your blood sugar is too high, fluid may be pulled from the lenses of your eyes: This may affect your ability to focus
Increased hunger
 
  • Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy: This triggers intense hunger
Slow-healing sores or frequent infections
 
  • Type 2 diabetes affects your ability to heal and resist infections
Areas of darkened skin
 
  • Some people with type 2 diabetes have patches of dark, velvety skin in the folds and creases of their bodies — usually in the armpits and neck: This condition, called acanthosis nigricans, may be a sign of insulin resistance
Type 2 diabetes in children may develop gradually. Some children who have type 2 diabetes have no signs or symptoms. Others experience:
 
  • Increased thirst and urination:  As excess sugar builds up in your child's bloodstream, fluid is pulled from the tissues. This may leave your child thirsty. As a result, your child may drink — and urinate — more than usual
  • Increased hunger:  Without enough insulin to move sugar into your child's cells, your child's muscles and organs become depleted of energy. This triggers hunger
  • Weight loss:  Despite eating more than usual to relieve hunger, your child may lose weight. Without the energy that sugar supplies to your cells, muscle tissues and fat stores simply shrink
  • Fatigue:  If your child's cells are deprived of sugar, he or she may become tired and irritable
  • Blurred vision:  If your child's blood sugar is too high, fluid may be pulled from the lenses of your child's eyes. This may affect your child's ability to focus clearly
  • Slow-healing sores or frequent infections:  Type 2 diabetes affects your child's ability to heal and resist infections
  • Areas of darkened skin:  Areas of darkened skin (acanthosis nigricans) may be a sign of insulin resistance. These dark patches often occur in the armpits or neck

Tests

Anyone with a body mass index higher than 25, regardless of age
 
  • who has additional risk factors, such as high blood pressure, a sedentary lifestyle, a history of polycystic ovary syndrome, having delivered a baby who weighed more than 9 pounds, a history of diabetes in pregnancy, high cholesterol levels, a history of heart disease, and having a close relative with diabetes
Anyone older than age 45
 
  • is advised to receive an initial blood sugar screening, and then, if the results are normal, to be screened every three years thereafter
Tests for type 1 and type 2 diabetes and prediabetes
 
  • Glycated hemoglobin (A1C) test:  This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar 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 of 6.5 percent or higher on two separate tests indicates that you have diabetes. An A1C between 5.7 and 6.4 percent indicates prediabetes. Below 5.7 is considered normal
  • Random blood sugar test:  A blood sample will be taken at a random time. Regardless of when you last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1 millimoles per liter (mmol/L) — or higher suggests diabetes
  • Fasting blood sugar test:  A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes
  • Oral glucose tolerance test:  For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours indicates diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes
Tests for gestational diabetes
 
  • If you're at high risk of gestational diabetes — for example, if you were obese at the start of your pregnancy, 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 prenatal 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 below 140 mg/dL (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 you have a higher risk of gestational diabetes. Your doctor will order a follow-up test to determine if you have gestational diabetes
  • Follow-up glucose tolerance testing:  For the follow-up 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 the normal values established for each of the three hours of the test, you'll be diagnosed with gestational diabetes
After the diagnosis
 
  • A1C levels need to be checked between two and four times a year: Your target A1C goal may vary depending on your age and other factors. However, for most people, the American Diabetes Association recommends an A1C level below 7 percent. Ask your doctor what your A1C target is. Compared with repeated daily blood sugar tests, A1C testing better indicates how well your diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your medication, meal plan or activity level. In addition to the A1C test, the doctor will take blood and urine samples periodically to check your cholesterol levels, thyroid function, liver function and kidney function. The doctor will also assess your blood pressure. Regular eye and foot exams also are important
  • At first, your child may need frequent visits to various members of his or her health care team, such as the doctor and dietitian: Once your child's blood sugar is stabilized, he or she will regularly visit his or her doctor to ensure good diabetes management. The American Academy of Pediatrics (AAP) recommends A1C testing every three months to ensure blood sugar level goals are met. Your child's target A1C goal may vary depending on his or her age and various other factors. Ask your doctor what your child's A1C target is. The American Diabetes Association has introduced a formula that translates the A1C into what's known as an estimated average glucose (eAG). The eAG more closely correlates with daily blood sugar readings. An A1C of 7 percent translates to an eAG of 154 mg/dL (8.6 mmol/L). Compared with repeated daily blood sugar tests, A1C testing better indicates how well your child's diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your child's insulin regimen or meal plan
Random blood sugar test
 
  • A blood sample will be taken at a random time: Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when your child last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes.
To diagnose type 2 diabetes, you'll be given a:
 
  • Glycated hemoglobin (A1C) test:  This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar 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 of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Normal levels are below 5.7 percent
If the A1C test isn't available, or if you have certain conditions — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — that can make the A1C test inaccurate, your doctor may use the following tests to diagnose diabetes:
 
  • Random blood sugar test:  A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst
  • Fasting blood sugar test:  A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes
  • Oral glucose tolerance test:  For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours.A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours indicates diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes.The American Diabetes Association recommends routine screening for type 2 diabetes beginning at age 45, especially if you're overweight. If the results are normal, repeat the test every three years. If the results are borderline, ask your doctor when to come back for another test.Screening is also recommended for people who are under 45 and overweight if there are other heart disease or diabetes risk factors present, such as a sedentary lifestyle, a family history of type 2 diabetes, a personal history of gestational diabetes or blood pressure above 140/90 millimeters of mercury (mm Hg).If you're diagnosed with diabetes, the doctor may do other tests to distinguish between type 1 and type 2 diabetes — since the two conditions often require different treatments
A1C (glycated hemoglobin) test
 
  • This blood test indicates an average blood sugar level for the past two to three months: It works by measuring the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher the blood sugar levels, the more hemoglobin that has sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates diabetes. A result of 5.7 to 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Another test your doctor might use is a fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, your child will be diagnosed with diabetes. Your doctor may also perform an oral glucose tolerance test. For this test, your child fasts overnight, and the fasting blood sugar level is measured. Then, your child drinks a sugary liquid, and blood sugar levels are tested periodically for the next several hours. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours indicates diabetes. A reading between 140 and 199 mg/dL (7.8 to 11 mmol/L) indicates prediabetes. If your child is diagnosed with diabetes, the doctor may do other tests to distinguish between type 1 and type 2 diabetes — which often require different treatment strategies because in type 1 diabetes, the pancreas no longer makes insulin
Other periodic tests
 
  • In addition to the A1C test, the doctor will also periodically check your child's cholesterol levels, thyroid function, liver function and kidney function using blood and urine samples: The doctor will also examine your child to assess his or her blood pressure and make sure he or she is growing properly. Regular eye exams also are important

Treatments

 
  • Discuss the pros and cons of different drugs with your doctor: Together you can decide which medication is best for you after considering many factors, including costs and other aspects of your health. In addition to diabetes medications, your doctor might prescribe low-dose aspirin therapy as well as blood pressure and cholesterol-lowering medications to help prevent heart and blood vessel disease
Monitoring your blood sugar
 
  • Depending on your treatment plan, you may check and record your blood sugar level every now and then or, if you're on insulin, multiple times a day: Ask your doctor how often he or she wants you to check your blood sugar. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. Sometimes, blood sugar levels can be unpredictable. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to food, exercise, alcohol, illness and medication
Pregnancy
 
  • Women with type 2 diabetes may need to alter their treatment during pregnancy: Many women use insulin therapy during pregnancy. Cholesterol-lowering medications and some blood pressure drugs can't be used during pregnancy. If you have signs of diabetic retinopathy, it may worsen during pregnancy. Visit your ophthalmologist during the first trimester of your pregnancy and at one year postpartum
Physical activity
 
  • Everyone needs regular aerobic exercise, and people who have type 2 diabetes are no exception: Get your doctor's OK before you start an exercise program. Then choose activities you enjoy, such as walking, swimming and biking. What's most important is making physical activity part of your daily routine. Aim for at least 30 minutes of aerobic exercise most days of the week. Stretching and strength training exercises are important, too. If you haven't been active for a while, start slowly and build up gradually. A combination of exercises — aerobic exercises, such as walking or dancing on most days, combined with resistance training, such as weightlifting or yoga twice a week — often helps control blood sugar more effectively than either type of exercise alone. Remember that physical activity lowers blood sugar. Check your blood sugar level before any activity. You might need to eat a snack before exercising to help prevent low blood sugar if you take diabetes medications that lower your blood sugar
  • Everyone needs regular aerobic exercise, and children who have type 2 diabetes are no exception: The AAP recommends children and adolescents with type 2 diabetes get at least 60 minutes of moderate-to-vigorous activity daily and limit nonacademic-related time in front of televisions, computers and handheld devices to less than two hours a day. Sign up for a sports team or dance lessons. Better yet, get in the act together. Play catch in the backyard. Take a walk or run through your neighborhood. Visit an indoor climbing wall or local pool. Make physical activity part of your child's daily routine. Physical activity lowers blood sugar. If your child needs insulin treatment, check your child's blood sugar level before any activity. He or she might need a snack before exercising to help prevent low blood sugar
Treatments for all types of diabetes
 
  • Healthy eating:  Contrary to popular perception, there's no specific diabetes diet. You'll need to center your diet on more fruits, vegetables and whole grains — foods that are high in nutrition and fiber and low in fat and calories — and cut down on animal products, refined carbohydrates and sweets. In fact, it's the best eating plan for the entire family. Sugary foods are OK once in a while, as long as they're counted as part of your meal plan.Yet understanding what and how much to eat can be a challenge. A registered dietitian can help you create a meal plan that fits your health goals, food preferences and lifestyle. This will likely include carbohydrate counting, especially if you have type 1 diabetes
  • Physical activity:  Everyone needs regular aerobic exercise, and people who have diabetes are no exception. Exercise lowers your blood sugar level by moving sugar into your cells, where it's used for energy. Exercise also increases your sensitivity to insulin, which means your body needs less insulin to transport sugar to your cells. Get your doctor's OK to exercise. Then choose activities you enjoy, such as walking, swimming or biking. What's most important is making 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
 
  • Monitoring your blood sugar:  Depending on your treatment plan, you may check and record your blood sugar as often as several times a week to as many as four to eight times a day. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. People who receive insulin therapy also may choose to monitor their blood sugar levels with a continuous glucose monitor. Although this technology doesn't yet replace the glucose meter, it can provide important information about trends in blood sugar levels.Even with careful management, blood sugar levels can sometimes change unpredictably. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to food, physical activity, medications, illness, alcohol, stress — for women, fluctuations in hormone levels.In addition to daily blood sugar monitoring, your doctor will likely recommend regular A1C testing to measure your average blood sugar level for the past two to three months. Compared with repeated daily blood sugar tests, A1C testing better indicates how well your diabetes treatment plan is working overall. An elevated A1C level may signal the need for a change in your insulin regimen or meal plan. Your target A1C goal may vary depending on your age and various 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 target is
  • Insulin:  People with type 1 diabetes need insulin therapy to survive. Many people with type 2 diabetes or gestational diabetes also need insulin therapy.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 mixture of insulin types to use throughout the day and night.Insulin can't be taken orally to lower blood sugar because stomach enzymes interfere with insulin's action. Often insulin is injected using a fine needle and syringe or an insulin pen — a device that looks like a large ink pen.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. A tube connects the reservoir of insulin to a catheter that's inserted under the skin of your abdomen. A tubeless pump that works wirelessly is also now available. You program an insulin pump to dispense specific amounts of insulin. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.An emerging treatment approach, not yet available, is 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 the need for it. There are a number of different versions of the artificial pancreas, and clinical trials have had encouraging results. More research needs to be done before a fully functional artificial pancreas can receive regulatory approval.However, the first step toward an artificial pancreas was approved in 2013. Combining a continuous glucose monitor with an insulin pump, this system stops insulin delivery when blood sugar levels drop too low. Studies on the device found that it could prevent low blood sugar levels overnight without significantly increasing morning blood sugar levels
  • Oral or other medications:  Sometimes other oral or injected medications are prescribed as well. Some diabetes medications stimulate your pancreas to produce and release more insulin. Others inhibit the production and release of glucose from your liver, which means you need less insulin to transport 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. Metformin (Glucophage, Glumetza, others) is generally the first medication prescribed for type 2 diabetes
  • Transplantation:  In some people who have type 1 diabetes, a pancreas transplant may be an option. Islet 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. You need a lifetime of immune-suppressing drugs 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 also need a kidney transplant
  • Bariatric surgery:  Although it is not specifically considered a treatment for type 2 diabetes, people with type 2 diabetes who also have a body mass index 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
Treatment for gestational diabetes
 
  • Controlling your blood sugar level is essential to keeping your baby healthy and avoiding complications during delivery: In addition to maintaining a healthy diet and exercising, your treatment plan may include monitoring your blood sugar and, in some cases, using insulin or oral medications.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
Treatment for prediabetes
 
  • If you have prediabetes, healthy lifestyle choices can help you bring your blood sugar level back to normal or at least keep it from rising toward the levels seen in type 2 diabetes: Maintaining a healthy weight through exercise and healthy eating can help. Exercising at least 150 minutes a week and losing 5 to 10 percent of your body weight may prevent or delay type 2 diabetes.Sometimes medications — such as metformin (Glucophage, Glumetza, others) — also are an option if you're at high risk of diabetes, including when your prediabetes is worsening or if you have cardiovascular disease, fatty liver disease or polycystic ovary syndrome.In other cases, medications to control cholesterol — statins, in particular — and high blood pressure medications are needed. Your doctor might prescribe low-dose aspirin therapy to help prevent cardiovascular disease if you're at high risk. Healthy lifestyle choices remain key, however
Signs of trouble in any type of diabetes
 
  • High blood sugar (hyperglycemia):  Your blood sugar level can rise for many reasons, including eating too much, being sick or not taking enough glucose-lowering medication. Check your blood sugar level as directed by your doctor, and watch for signs and symptoms of high blood sugar — frequent urination, increased thirst, dry mouth, blurred vision, fatigue and nausea. If you have hyperglycemia, you'll need to adjust your meal plan, medications or both
  • 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, consult 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 sky-high blood sugar that turns blood thick and syrupy. It tends to be more common in people with type 2 diabetes, and it's often preceded by 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 your target range, it's known as low blood sugar (hypoglycemia). Your blood sugar level can drop for many reasons, including skipping a meal and getting more physical activity than normal. However, low blood sugar is most likely if you take glucose-lowering medications that promote the secretion of insulin by your pancreas or if you're receiving insulin therapy. Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar — sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations, irritability, slurred speech, drowsiness, confusion, fainting and seizures. Low blood sugar is treated with quickly absorbed carbohydrates, such as fruit juice or glucose tablets
Blood sugar monitoring
 
  • Depending on what type of medication (if any) your child needs, you may need to check and record your child's blood sugar at least daily, possibly more often: This usually requires finger sticks, though some blood glucose meters allow for testing at other sites. Children who need insulin therapy will need to check their blood sugar levels at least three times a day. Ask your doctor how often your child needs to test his or her blood sugar.
Signs of trouble
 
  • High blood sugar (hyperglycemia):  Your blood sugar level can rise for many reasons, including eating too much, being sick or not taking enough glucose-lowering medication. Check your blood sugar level as directed by your doctor, and watch for signs and symptoms of high blood sugar — frequent urination, increased thirst, dry mouth, blurred vision, fatigue and nausea. If you have hyperglycemia, you'll need to adjust your meal plan, medications or both
  • 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, consult your doctor right away or seek emergency care. This condition is more common in people with type 1 diabetes
  • Low blood sugar (hypoglycemia):  If your blood sugar level drops below your target range, it's known as low blood sugar (hypoglycemia). Your blood sugar level can drop for many reasons, including skipping a meal and getting more physical activity than normal. However, low blood sugar is most likely if you take glucose-lowering medications that promote the secretion of insulin by your pancreas or if you're receiving insulin therapy. Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar — sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations, irritability, slurred speech, drowsiness, confusion, fainting and seizures. Low blood sugar is treated with quickly absorbed carbohydrates, such as fruit juice or glucose tablets
  • Hyperglycemic hyperosmolar nonketotic syndrome (HHNS):  Signs and symptoms of this life-threatening condition include a blood sugar reading higher than 600 mg/dL (33.3 mmol/L), dry mouth, extreme thirst, fever greater than 101 F (38 C), drowsiness, confusion, vision loss, hallucinations and dark urine. Your blood sugar monitor may not be able to give you an exact reading at such high levels and may instead just read "high." HHNS is caused by sky-high blood sugar that turns blood thick and syrupy. It tends to be more common in older people with type 2 diabetes, and it's often preceded by an illness or infection. HHNS usually develops over days or weeks. Call your doctor or seek immediate medical care if you have signs or symptoms of this condition
  • Low blood sugar (hypoglycemia):  If your child's blood sugar level drops below the normal range, it's known as low blood sugar (hypoglycemia). Your child's blood sugar level can drop for many reasons, including skipping a meal, getting more physical activity than normal or accidentally injecting too much insulin.
Healthy eating
 
  • Contrary to popular perception, there's no diabetes diet: Your child won't be restricted to a lifetime of boring, bland foods. Instead, your child will need plenty of fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories.Your child's dietitian will likely suggest that your child — and the rest of the family — consume fewer animal products and sweets. In fact, it's the best eating plan for the entire family. Sugary foods are OK once in a while, as long as they're included in your child's meal plan.Yet understanding what and how much to feed your child can be a challenge. A registered dietitian can help you create a meal plan that fits your child's health goals, food preferences and lifestyle.Certain foods, such as those with a high sugar or fat content, may be more difficult to incorporate into your child's meal plan than healthier choices. For example, high-fat foods — because fat slows digestion — may cause a spike in blood sugar several hours after your child has eaten.Unfortunately, there's no set formula to tell you how your child's body will process different foods. But, as time passes, you'll learn more about how your child's favorites affect his or her blood sugar, and then you can learn to compensate for them.
  • Fruits
  • Vegetables
  • Whole grains
Management of type 2 diabetes includes:
 
  • Healthy eating
  • Regular exercise
  • Possibly, diabetes medication or insulin therapy
  • Blood sugar monitoring
Diabetes medications and insulin therapy
 
  • Metformin (Glucophage, Glumetza, others):  Generally, metformin is the first medication prescribed for type 2 diabetes. It works by improving the sensitivity of your body tissues to insulin so that your body uses insulin more effectively. Metformin also lowers glucose production in the liver. Metformin usually won't lower blood sugar enough on its own. Your doctor will also recommend lifestyle changes, such as losing weight and becoming more active. Nausea and diarrhea are possible side effects of metformin. These side effects usually go away as your body gets used to the medicine. If metformin and lifestyles changes aren't enough to control your blood sugar level, other oral or injected medications can be added
  • Sulfonylureas:  These medications help your body secrete more insulin. Examples of medications in this class include glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl). Possible side effects include low blood sugar and weight gain
  • Meglitinides:  These medications work like sulfonylureas by encouraging the body to secrete more insulin, but they're faster acting, and they don't stay active in the body for as long. They also have a risk of causing low blood sugar, but not as much risk as sulfonylureas do. Weight gain is a possibility with this class of medications as well. Examples include repaglinide (Prandin) and nateglinide (Starlix)
  • Thiazolidinediones:  Like metformin, these medications make the body's tissues more sensitive to insulin. This class of medications has been linked to weight gain and other more serious side effects, such as an increased risk of heart failure and fractures. Because of these risks, these medications generally aren't a first-choice treatment. Rosiglitazone (Avandia) and pioglitazone (Actos) are examples of thiazolidinediones
  • DPP-4 inhibitors:  These medications help reduce blood sugar levels, but tend to have a modest effect. They don't seem to cause weight gain. Examples of these medications are sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta)
  • GLP-1 receptor agonists:  These medications slow digestion and help lower blood sugar levels, though not as much as sulfonylureas. This class of medications isn't recommended for use alone. Exenatide (Byetta) and liraglutide (Victoza) are examples of GLP-1 receptor agonists. Possible side effects include nausea and an increased risk of pancreatitis
  • SGLT2 inhibitors:  These are the newest diabetes drugs on the market. They work by preventing the kidneys from reabsorbing sugar in the blood. Instead, the sugar is excreted in the urine. Examples include canagliflozin (Invokana) and dapagliflozin (Farxiga). Side effects may include yeast infections and urinary tract infections
Diabetes medications and insulin therapy Insulin therapy. Some people who have type 2 diabetes need insulin therapy as well. In the past, insulin therapy was used as last resort, but today it's often prescribed sooner because of its benefits. Because normal digestion interferes with insulin taken by mouth, insulin must be injected. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night. Often, people with type 2 diabetes start insulin use with one long-acting shot at night. Insulin injections involve using a fine needle and syringe or an insulin pen injector — a device that looks similar to an ink pen, except the cartridge is filled with insulin. There are many types of insulin, and they each work in a different way. Options include:
 
  • Insulin glulisine (Apidra)
  • Insulin lispro (Humalog)
  • Insulin aspart (Novolog)
  • Insulin glargine (Lantus)
  • Insulin detemir (Levemir)
  • Insulin isophane (Humulin N, Novolin N)
Bariatric surgery
 
  • If you have type 2 diabetes and your body mass index (BMI) is greater than 35, you may be a candidate for weight-loss surgery (bariatric surgery): Blood sugar levels return to normal in 55 to 95 percent of people with diabetes, depending on the procedure performed. Surgeries that bypass a portion of the small intestine have more of an effect on blood sugar levels than do other weight-loss surgeries. Drawbacks to the surgery include cost, and there are risks involved, including a risk of death. Additionally, drastic lifestyle changes are required and long-term complications may include nutritional deficiencies and osteoporosis
Even if your child eats on a rigid schedule, the amount of sugar in his or her blood can change unpredictably. With help from your child's diabetes treatment team, you'll learn how your child's blood sugar level changes in response to:
 
  • Food: What and how much your child eats will affect your child's blood sugar level
  • Physical activity: Physical activity moves sugar from your child's blood into his or her cells. The more active your child is, the lower his or her blood sugar level
  • Medication: Any medications your child takes may affect his or her blood sugar level, sometimes requiring changes in your child's diabetes treatment plan
  • Illness: During a cold or other illness, your child's body will produce hormones that raise his or her blood sugar level.
Medication and insulin
 
  • Medication:  The AAP recommends metformin (Fortamet, Glucophage, Glumetza) for all children who have type 2 diabetes. Metformin reduces the amount of sugar a child's liver releases into the bloodstream between meals. Side effects may include nausea, upset stomach, diarrhea and headaches. Metformin isn't safe for anyone who has liver failure, kidney failure or heart failure, since in patients with these conditions a harmful buildup of lactic acid (lactic acidosis) can occur if metformin is used
Medication and insulin Insulin.The AAP also recommends insulin therapy if your child:
 
  • Has random blood glucose levels of 250 mg/dL (13: 9 mmol/L) or higher
  • Has A1C levels of greater than 9 percent
  • Has excess ketones (toxic acids) in his or her urine (diabetic ketoacidosis)
  • May have type 1 diabetes:
Because stomach enzymes interfere with insulin taken by mouth, oral insulin isn't an option for lowering blood sugar. Therefore, if insulin is necessary, it has to be delivered under the skin. Insulin delivery options include:
 
  • Injections: Usually, insulin delivery means injections using a fine needle and syringe or an insulin pen — a device that looks like an ink pen, except the cartridge is filled with insulin:
  • Insulin pump: An insulin pump also may be an option for some children. The pump is a device about the size of a cellphone worn on the outside of the body. A tube connects the reservoir of insulin to a catheter that's inserted under the skin of the abdomen. A wireless pump that uses small pods filled with insulin is another option that's now available. The pump is programmed to dispense specific amounts of insulin automatically. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level. Many types of insulin are available, including rapid-acting insulin, long-acting insulin and intermediate options. The decision about which treatment is best depends on the child, his or her blood sugar level, and the presence of any other health problems. Initially, children whose blood sugar is above 250 mg/dL(13.9 mmol/L) or who have an A1C above 9 percent will likely be started on insulin therapy to stabilize the blood sugar. Once blood sugar levels are normalized, your child may be weaned off insulin and placed on metformin alone. However, if blood sugar isn't well-controlled with metformin and lifestyle changes, insulin will have to be given again. A long-acting insulin, such as insulin glargine (Lantus), is often used for type 2 diabetes in children
Watch for:
 
  • Headaches
  • Shakiness
  • Sweating
  • Hunger
  • Irritability
  • Confusion
  • Nausea
  • Vomiting
  • Abdominal pain
  • Drowsiness
  • Dizziness
  • Dramatic behavior changes
  • Loss of consciousness
  • Loss of appetite
  • Dry or flushed skin
  • A sweet, fruity smell on your child's breath
  • Difficulty breathing
  • Exhaustion
Treating low blood sugar
 
  • If your child has signs or symptoms of low blood sugar, give him or her fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar equivalent to 15 grams of carbohydrate, and then recheck the blood sugar levels in 15 minutes: If the blood sugar reading is still low, give your child another fast-acting source of sugar, and retest again in 15 minutes. Once the blood sugar reaches a normal level, give your child a mixed food snack, such as peanut butter and crackers, to stabilize the blood sugar levels. If your child loses consciousness, he or she may need an emergency injection of glucagon — a hormone that stimulates the release of sugar into the blood. This is a medical emergency.
High blood sugar (hyperglycemia).
 
  • Likewise, your child's blood sugar can rise for many reasons, including eating too much, not taking enough insulin or illness: :
Watch for
 
  • Fatigue
  • Blurred vision
  • Frequent urination
  • Increased thirst
  • Nausea
  • Dry mouth
  • Yeast infection, often in the diaper area in infants and toddlers
Treating high blood sugar
 
  • If you suspect hyperglycemia, check your child's blood sugar: You might need to adjust your child's meal plan or medications. If your child's blood sugar is persistently above the target range set by your child's doctor, call your child's doctor right away or seek emergency care
Increased ketones in your child's urine (diabetic ketoacidosis)
 
  • If your child's cells are starved for energy, your child's body may begin to break down fat — producing potentially toxic acids known as ketones: Although this condition is more common in children with type 1 diabetes, it can occur in children with type 2 diabetes
Treating increased ketones
 
  • If you suspect ketoacidosis, check your child's urine for excess ketones with an over-the-counter ketones test kit: If your child has excess ketones in his or her urine, call your child's doctor right away or seek emergency care