Diabetes:A Comprehensive Guide

Origin Of Diabetes

Diabetes is an ancient disease. Historians trace the earliest mentions of diabetes back to the Ancient Egyptian Civilisation in the 1550B.C. Many different cultures mention this affliction with different names; like the ancient Byzantine, Indian, Greek, Roman, and Chinese civilisations. Even the well-known physicians of the Islamic Golden Age, like Bu-Ali-Sina (known in the West as Avicenna), have described diabetes in detail.

Statistics for Diabetes

• World Health Organisation estimates there are more than 422 million patients with diabetes in the world. This figure is likely to rise to 642 million in the year 2040.
• Every 11th person in the world suffers from this disease.
• Around 46% of diabetes patients remain undiagnosed.
• Type 2 diabetes is, by far, the most common. It accounts for more than 90% of all cases of diabetes.
• Life expectancy for type 1 diabetic patients is reduced by 20 years.
• Life expectancy for type 2 diabetic patients is reduced by 10 years.
• 3% of all deaths in Pakistan happen because of diabetes.
• Around 10% of the Pakistani population is a patient of diabetes.
• Every 5th Pakistani suffers from prediabetes.
• Pakistani women are five times more likely to develop diabetes compared to the world female population.
• Pakistan has the 4th highest cases of diabetes in the world, with 19.4 million cases in 2019.

You must have realised by now how widely spread this disease is in our country and the world. Scroll down and continue to learn valuable information about its classifications and types so you can better understand and protect yourself and your family.

Type 1 Diabetes

This condition generally occurs when the body does not produce enough insulin. In a healthy body, insulin is the key that allows cells to absorb energy from glucose. Without insulin production, the blood sugar level continues to rise and leads to complications.

Progression of Type 1 Diabetes

A healthy immune system attacks the cells that cause harm to the body. Type 1 diabetes causes the immune system to deviate from its normal functioning by attacking the pancreas’ healthy cell clusters, called islets.

Islets produce insulin in the body. Without them, insulin production slows down or completely stops. This halts the absorption of glucose by the cells, causing the blood sugar level to rise. This process may carry on for years without being diagnosed due to a lack of symptoms.

Common Age of Affliction

Type 1 diabetes can happen at any age. However, it is more prevalent among children and young adults. That’s why it is also called Juvenile Diabetes. Most of the time, it manifests after the age of 5. But some people do not develop this condition until their late 30s (Latent Autoimmune Diabetes of Adulthood or LADA).

Overall Prevalence

Type 1 diabetes is way less common than type 2 diabetes. Among all the patients with diabetes, only 5-10% develop type 1.

Type 2 Diabetes

This is by far the most common type of diabetes. Type 2 diabetes is a condition that occurs when the body develops insulin resistance. Since insulin does not work, the blood sugar level continues to rise, and in turn, the pancreas produces more insulin.

This can eventually lead the pancreas to stop working, causing a sharp decrease in insulin production. This results in the blood sugar level to rise even more, potentially leading to severe complications.

Progression of Type 2 Diabetes

Unlike type 1 diabetes, the pancreas still produces insulin, but the cells are unable to respond to it. Glucose cannot enter the cells and provide them with much needed nourishment. Blood sugar level continues to rise, which prompts the pancreas to produce even more insulin.

Eventually, the pancreas exhausts itself and stops or slows down insulin production. This causes blood sugar to rise even more. Too much blood sugar in the body causes a condition called Hyperglycemia. This condition may cause you to urinate frequently, feel an intense thirst to counter the urination, and feel an unusual amount of fatigue in your body.

Common Age of Affliction

Type 2 diabetes mostly affects people over the age of 45. However, an alarming number of children, teens, and young adults are also developing it. The senior population may be at a greater risk of developing this condition. However, you can still initiate steps to reduce its likelihood at any age.

Overall Prevalence

Type 2 diabetes is the most common form of this disease. According to an estimate, it accounts for 90-95% of all diabetic patients.

Gestational Diabetes

This type of diabetes develops in females during pregnancy. It can happen at any stage of pregnancy. However, it is more common in the 2nd or 3rd trimester. Gestational diabetes happens when your body cannot produce enough insulin, causing it to fail in absorbing sufficient glucose.

This condition can cause complications for the mother, as well as the child during pregnancy. Yet, it is manageable with timely diagnosis and appropriate steps.

When not counting as a subcategory of type 2, it can account for around 12% of all cases of diabetes.
In the majority of cases, this disorder resolves itself after childbirth.

Gestational diabetes can create several problems for you. It may cause;

Gestational diabetes can create several problems for you. It may cause;

• The abnormally large size of your newborn. This may increase the need for induced labour or a caesarian section.
• Production of too much amniotic fluid in your womb. It may trigger premature birth.
• High blood pressure during pregnancy. It may cause complications to the heart, kidneys, eyes, etc., for the mother.
• The baby develops low blood sugar or yellowing of the skin and eyes (jaundice).
• The loss of pregnancy in a stillbirth. (extremely rare)

Overall Prevalence

Gestational diabetes can affect up to 12% of all pregnant women. This makes it one of the top health concerns in pregnancy. However, early diagnosis and proper treatment significantly reduce the risks.

Monogenic Diabetes

Monogenic diabetes is a rare type that is different from both type 1 and type 2. It runs strongly in a family. A mutation in a single gene generally causes it. If a parent has this mutation, their child has a 50% chance of inheriting it.

It may appear in several forms. In most cases, 25-year-olds or younger develop this condition. The body fails to produce enough insulin in the majority of cases of monogenic diabetes. That is why it is often misdiagnosed as type 1 diabetes. A correct and timely diagnosis benefits the patient and the other family members as they can take timely precautions.

Subcategories

• Maturity Onset Diabetes of the Young (MODY) is the most common form of monogenic diabetes. It can occur in both children and teenagers. However, a proper diagnosis may not happen until adulthood. It can be mild or severe, depending upon the gene involved.
• Neonatal Diabetes occurs rarely. It affects infants in the first 6 months of birth. It may cause the baby to grow abnormally. The baby may be small and have a low weight for its age. It has further two types;
  • Permanent Neonatal Diabetes is a lifelong condition and requires lifelong treatment
  • Transient Neonatal Diabetes usually goes away during infancy and may return later in life.

Progression of Monogenic Diabetes

Several genetic mutations can cause monogenic diabetes. All of these mutations limit the ability of the pancreas to produce insulin. It is very similar to type 1 diabetes. The main difference is that the cause of type 1 remains unknown, while a genetic mutation causes monogenic diabetes.

The specific clinical features differ with each subcategory. Certain mutations cause a slight elevation in blood sugar levels that remain stable throughout life. Such a mild disorder may not cause long-term complications. However, other mutations may cause more significant complications and even require insulin or other diabetic medication for treatment.

Common Age of Affliction

Most cases of monogenic diabetes affect young people, specifically those younger than 25.
MODY can affect both children and young adults. It may not be diagnosed until later in life.
Neonatal diabetes occurs at a very young age. It can affect infants within 6 months of their lives.

Overall Prevalence

The monogenic disorder is the cause of 1-4% of all diabetic cases. Some of its subcategories show similar symptoms as other common forms of diabetes, like type 1 and type 2. That is why it is often misdiagnosed.

PCOS Related Diabetes

Poly-Cystic Ovary Syndrome or PCOS is one of the most common causes of female infertility. It affects 2-26% of all adult females. PCOS often causes insulin resistance. That is why it is a major factor in the development of type 2 diabetes.

Both PCOS and Diabetes are incurable. However, proper care, exercise, treatment, etc., can help the patient live a quality life.

Progression of PCOS Related Diabetes

Experts believe there is a direct link between PCOS and type 2 diabetes. PCOS disrupts the natural hormonal balance in the female body and increases the male hormone called Androgen. This increases insulin resistance, resulting in diabetes.

Typically it is possible to prevent type 2 diabetes with a strict diet regimen, exercise, and lifestyle changes. However, PCOS is a strong and independent risk factor.

Common Age of Affliction

More than half of PCOS patients develop type 2 diabetes by the age of 40. The average contraction age of diabetes in women suffering from PCOS is 31.

Overall Prevalence

PCOS is one of the most commonly known factors behind female infertility in the world. It affects about 2-26% of the female population. The correct figures are hard to predict, but according to estimates, more than 50% of such cases remain undiagnosed.

50% of all women suffering from PCOS develop type 2 diabetes by the age of 40. According to an estimate, women carrying PCOS are 4 to 8 times more likely to develop type 2 diabetes as compared to others.

Steroid Induced Diabetes

Corticosteroids are often used to treat inflammation. Sometimes, they are likely to reduce the immune system activity that may lead to type 2 diabetes development.

It can occur in any person whether they have a prior history of diabetes or not.

Is it Reversible?

Most of the time, this condition reverses itself as soon as you stop taking corticosteroids.

However, in some rare cases, it can develop into full-blown type 2 diabetes. This only happens when the patient has a personal or familial history of diabetes.

Progression of Steroid Induced Diabetes

Corticosteroid medicine directly affects the body’s immune system. It reduces inflammation and treats several other disorders by mimicking the action of cortisol, a natural hormone produced in the kidneys. It may cause your body to become insulin resistant, thereby contributing to the rise in blood pressure and blood sugar level.

Double Diabetes

Double diabetes is a condition in which both type 1 and type 2 develop simultaneously. Type 1 diabetes causes your pancreas to reduce insulin production, and type 2 prohibits your body to process insulin. Double diabetes results in the combined manifestation of both disorders.

Progression of Double Diabetes

• How type 1 patients also develop type 2 diabetes? Generally, people who already have type 1 end up developing type 2 because of obesity or other factors.
  In type 1 diabetes, the insulin-producing cells get damaged in the pancreas. Carelessness on the part of the patient makes them obese, increasing insulin resistance, and giving rise to type 2 diabetes.
• How type 2 patients also develop type 1 diabetes?The cells become insulin resistant in type 2. This causes the pancreas to work overtime and develop greater quantities of insulin. Eventually, the pancreas exhausts itself and leads to a complete shutdown. This is how type 2 patients end up being dependant on an external source of insulin for survival.

Overall Prevalence

Physicians all over the world are diagnosing more and more cases of double diabetes. According to an estimate, 30% of all newly diagnosed cases of diabetes among children and adolescents involve double diabetes.

Prediabetes

Prediabetes, also called ‘borderline diabetes,’ is closely tied to obesity. In this condition, your blood sugar level is higher than average but not high enough to be classified as diabetes. It is one of the most common conditions in the world.

Without appropriate treatment, it may lead to type 2 diabetes, stroke, and heart disease. According to an estimate, more than 70% of people with prediabetes will develop type 2 diabetes within 10 years if they do not make significant lifestyle changes.

Is Prediabetes Reversible?

Unlike other forms of diabetes, prediabetes is completely reversible with appropriate changes in lifestyle, diet, and body mass index (BMI).

Progression of Prediabetes

Prediabetes rarely shows any visible symptoms that are indicative of an illness. Many patients can live for years without being aware of it. The majority of them only become aware of it when they develop type 2 diabetes.

In this condition, your body develops slight insulin resistance, causing your blood sugar levels to rise. This may lead to type 2 diabetes, heart disease, and stroke. It can also damage the kidneys, prohibiting them from filtering the blood efficiently. This may cause waste to build up in your body.

Common Age of Affliction

It can generally develop at any age; however, the risk of prediabetes significantly increases after the age of 45.

Overall Prevalence

According to an estimate, every third individual in the United States and every fourth in Pakistan is overweight, therefore, is at risk of developing prediabetes.

You have done excellent work learning all about different types of diabetes. Now you must be wary. Learning to identify the symptoms of this disorder may ease your worries.

Diabetes Symptoms Visuals

Blurred Vision

High blood sugar makes it difficult for the eyes to focus. It destroys the blood vessels in the retina. Generally, diabetes can remain undetectable for years without symptoms. The onset of blurred vision is usually the first symptom that lets the patient know something is wrong. It is indicative of type 2 diabetes in the majority of the cases, but it can also indicate other rarer types.

Frequent Urination

Kidneys work overtime to expel extra sugar from our system, which results in frequent urination. Some people even have to get up at night multiple times to urinate. Generally, this symptom is indicative of all types of diabetes. This factor may increase bedwetting chances in children, especially after not having done it for some time.

Increased Hunger

The body fails to consume energy from glucose. This results in the continued yearning for food even after eating. This symptom is also indicative in all types of diabetes but does not always manifest.

Increased Thirst

Kidneys work overtime to expel extra sugar from the body. They even pull fluids from the tissues, resulting in frequent feelings of thirst. Not consuming a sufficient quantity of water may even cause water deficiency in patients with a severe condition. This symptom is indicative of all types of diabetes.

Weight Loss

The body fails to consume energy from the food. Increased urination also expels excess water and sugar, resulting in weight loss. Neither food nor water stays in the body. This causes sudden weight loss in patients with diabetes.

When the sudden weight loss occurs, it generally indicates that the disease has reached a certain advanced stage. This symptom is indicative of all types of diabetes.

Slow Healing

Slow-healing of the sores and wounds may indicate diabetes. High blood sugar slows down the blood flow. It prevents nutrients from reaching the injuries that help them heal. This symptom is also common in all types of diabetes.

Unusual Tiredness

The body fails to consume any energy from the food resulting in unusual tiredness. Generally, this symptom manifests early in the disease, but it is not severe enough for the patient to notice. Obese patients only assume their feeling of tiredness is because of the excess weight. This symptom is common in all types of diabetes.

Decreased Sex Drive

High blood sugar may cause a gradual decrease in the sex drive in both adult males and females. Since this symptom generally relates to type 2, it manifests at an advanced age. So the patient assumes it is due to old age.

Erectile Dysfunction

Male patients, especially those older than 40, experience erectile dysfunction. Just like decreased sex drive, this symptom remains undetected until proper testing and diagnosis. The patient typically assumes it is due to old age.

Poor Muscle Strength

Due to sudden weight loss and the cells’ inability to consume energy from glucose, muscles start losing their strength. This symptom is indicative of an advanced stage in all types of diabetes. Coupled with the nerve damage, some patients even lose the ability to walk without help.

Recurrent Infection of Mouth and Genitals

Patients with diabetes may face repeated infections of the mouth and genitals, such as yeast infection. This symptom mostly occurs because diabetes makes the immune system weak. This affects both men, women, as well as children.

Dryness

Diabetes expels the majority of water from the body. Kidneys work overtime to release excess glucose and may even drain tissues. Dryness in the mouth or genitals is a common side effect in all types of diabetes. Some women may even feel painful sensations during sexual activity due to vaginal dryness.

Irritability or Sudden Mood Changes

Advanced stage diabetes may cause hormonal imbalance that can manifest as sudden mood changes. It is generally indicative of diabetes in females but can also manifest in males to an extent.

Tingling Sensation

Diabetes may cause nerve damage to its patients. This may make them feel a sensation of tingling or itching in the hands and feet. This symptom is indicative of the advanced stage of diabetes.

Swollen Gums

Type 2 diabetes may sometimes cause this symptom. The immune system may weaken in diabetes and cause frequent infections of the mouth. Swelling in the gums may appear as an allergic reaction to an infection.

Increased Weight

Generally, a sudden decrease in weight is indicative of all types of diabetes. However, double diabetes and prediabetes are conditions in which the patient may experience a sudden weight gain.

Excellent work learning all about the different symptoms. Now the next thing you should know is the causes of diabetes. Learning about them is the only way you may be able to protect yourself from potential risk factors.

Type 1 Diabetes

Type 1 diabetes is classified as an autoimmune disease. The doctors and researchers have yet to establish the exact cause behind its occurrence. For some reason, the immune system itself starts attacking the insulin-producing cells in the pancreas.

The majority of the researchers speculate that some unidentified genetic factors, racial disposition, or obesity play a role in its occurrence. On the other hand, some researchers hold an unknown environmental factor, like a virus, at fault.

Type 1 diabetes usually manifests at two noticeable peaks. The first peak occurs in children aged 4-7 and the second in children aged 10-14 years. That is why it is also termed as “Juvenile Diabetes.”

Type 2 Diabetes

Type 2 diabetes is classified as a metabolic disorder that causes high blood sugar or Hyperglycemia in the body.

The doctors and researchers have yet to establish the exact cause behind its occurrence. For some reason, the cells do not respond to insulin. This causes blood sugar to rise. As a result, the pancreas starts producing even more insulin, eventually resulting in its exhaustion.

Obesity is one of its most prominent risk factors. More than 85% of people who develop type 2 diabetes are overweight.

Inactivity is another prominent risk factor, as it automatically leads to a buildup of fats in the body. This factor is especially relevant in people with desk jobs.

Some statistical studies also highlight the importance of racial disposition in the contraction of type 2 diabetes. South Asians, Native Americans, Hispanics, Pacific Islanders, and Black Africans are more likely to develop this disease under similar conditions as compared to Caucasians.

The risk of this disease seems to increase with age. The majority of the cases manifest over the age of 45 years.

Blood pressure above 140/90 (mm Hg) is linked directly to diabetes type 2.

Some hormonal conditions may cause insulin resistance in the body, but this risk factor is rare. This may lead to the development of type 2 diabetes;

• Cushing’s syndrome causes a high level of cortisol in your body. This hormone is directly related to stress. It raises the blood sugar level and may cause diabetes.
• Acromegaly is a condition that causes excess production of the growth hormone. If left untreated, it may lead to weight gain and diabetes.
• Hyperthyroidism causes an increase in the body’s metabolism. This may lead to an unintentional weight loss and the development of diabetes.

Gestational Diabetes

Placenta is an organ that develops in a pregnant female. It provides the necessary nutrients to the fetus and removes waste. Placenta makes hormones that cause your blood sugar to rise. Under normal circumstances, this can be easily countered by your pancreas, releasing extra insulin.

However, if your pancreas cannot keep up with glucose’s buildup, your blood sugar continues to rise. This causes gestational diabetes.

Obesity in women is considered one of its major causes. Gaining too much weight during pregnancy may also be a factor for gestational diabetes.

Monogenic Diabetes

Monogenic diabetes and its subcategories are inherited. It is caused by errors or mutations in a single gene.
If a parent carries this mutation, their child will have a 50% likelihood of carrying it as well. The child will go on to develop diabetes before the age of 25 regardless of their lifestyle, weight, ethnicity, etc.
There are almost 11 different genetic mutations that can cause it. The researchers are always discovering more mutations.

PCOS Related Diabetes

Poly-cystic ovary syndrome is one of the major causes of infertility all over the world. It affects 2-26% of all adult females.

Insulin resistance and weight gain due to PCOS are two major contributing factors that cause diabetes type 2.

Steroid Induced Diabetes

This form of diabetes is caused due to the side effects of taking corticosteroid medications. This class of drugs is generally used to reduce swelling. They may cause the immune system to diminish and make it harder for the cells to utilise insulin for glucose absorption.

Most cases of steroid-induced diabetes resolve themselves immediately after you stop taking the corticosteroid medication. However, if you are genetically, environmentally, or physically predisposed towards diabetes, it may persist or resurface in the future.

Double Diabetes

The exact cause behind type 1 and type 2 diabetes is unknown. However, weight gain or obesity can be the most significant factor in the emergence of type 2 diabetes.

Weight gain causes insulin resistance in the body. The pancreas works overtime to produce even more insulin and eventually exhausts itself. This factor may push a person with type 2 into type 1, resulting in double diabetes.

Similarly, a patient with type 1 may eventually develop insulin resistance due to carelessness and obesity. This factor may push a person with type 1 into type 2 diabetes, resulting in double diabetes.

Prediabetes

Obesity is one of the biggest factors that cause prediabetes. Obesity causes insulin resistance in the body. Unhealthy diet, long periods of inactivity, old age, and genetic predisposition are other causes that contribute towards the development of prediabetes.

Every 4th Pakistani is overweight, therefore, is at risk of developing prediabetes and eventual diabetes.

You are now sufficiently aware of the causes of Diabetes. Awareness is the best weapon you have against this disease. Avoid risk factors and live a healthy life. Exercise, proper diet, and an active lifestyle are the best ways you can keep yourself and your precious people safe.

Now you may wonder what happens to a patient if he or she already has diabetes. Scroll down to learn about the potential complications of diabetes.

Major Complications related to Diabetes (Visuals)

Heart Disorders (Cardiovascular Disorders)

Diabetes significantly increases the risk of various heart disorders; such as angina, heart attack, stroke, and the arteries’ narrowing.

Nerve Disorders (Neuropathy)

Excess blood sugar causes damage to the small blood vessels that supply nourishment to the nerves, especially in the legs. This may cause tingling, numbness, pain, cold, or burning that develops at the toes or fingers’ tip. Gradually, this sensation may travel upwards.

If left untreated, the patient may lose all feeling in the affected limbs. Damage to the nerves in the digestive system may cause nausea, vomiting, diarrhoea, and constipation.

Kidney Disorders (Nephropathy)

The kidneys contain millions of blood vessel clusters that help filter the waste from the body and expel it into the urine. This is a delicate filtering system.

High blood sugar causes the kidneys to work overtime so they can expel the excess glucose. This may destroy the delicate filtering system and cause severe damage to the kidneys. In extreme cases, the patient may even require dialysis or a kidney transplant to survive.

Vision Disorder (Retinopathy)

The most common complication of diabetes is damage to the blood vessels in the retina. This may increase the risk of eye disorders, like glaucoma, cataracts and even lead to blindness

Foot Damage (Gangrene)

Nerve damage and low blood flow in the feet increase the risk of various complications. If this condition is left untreated, the slow-healing cuts and bruises may get infected. Due to an already disturbed immune system, the body cannot fight infection properly.

This may lead to severe foot impairment and even gangrene. A severe complication may require a toe, foot, or leg to be amputated.

Skin Conditions

Diabetes may cause dryness in the skin due to the removal of excess water from the body. It may also upset the immune system. A combination of these conditions may leave the patient vulnerable to various skin conditions, including bacterial and fungal infections.

If left untreated, the patient may lose all feeling in the affected limbs. Damage to the nerves in the digestive system may cause nausea, vomiting, diarrhoea, and constipation.

Hearing Impairment

Some patients with diabetes may face hearing difficulties. This complication is rare, but it can happen.

Dementia

It is suspected that there is a link between an out of control case of diabetes and mental impairments. The direct relation between these two disorders has yet to be established. Still, the risk of cognitive impairments, specifically dementia, increases with increased blood sugar. Alzheimer’s disease is also seen in some complicated cases of diabetes.

Depression

Depression is common in patients with diabetes. This condition can affect treatment. It may also reduce the will to improve in the patient.

Reduced Sex Drive

This symptom is pretty common in patients with diabetes. Since this condition manifests above the age of 40 in most patients, they assume their reduced sex drive is due to advanced age. This can have an effect on both male and female patients.

Erectile Dysfunction

Some male patients suffer from erectile dysfunction due to nerve damage caused by diabetes.

Excess Fetus Growth

Gestational diabetes affects women during pregnancy. In addition to causing damage to the mother, it may also cause abnormal growth of the fetus. This can become dangerous for both the mother and the child. Sometimes, the only way to safely deliver an abnormally large baby is by artificially inducing labour or through a caesarian section.

Premature Birth

Sometimes, gestational diabetes may cause the baby to grow abnormally in weight and size. It may lead to an abnormal amount of amniotic fluid buildup in the womb. These two factors may lead to an earlier birth or, the gynaecologist may be forced to induce a premature birth to save both mother and child’s lives.

Infantile Death

A severe case of gestational diabetes may result in the death of the baby. This complication may be avoided by timely intervention and treatment.

Preeclampsia

This complication in pregnancy is identified by high blood pressure, extra protein in the urine, and swelling in the legs and feet. It usually begins after 20 weeks of pregnancy. This condition may cause the mother to gain excess weight. If left untreated, preeclampsia may result in severe complications for both mother and child.

A resurgence of Diabetes Later in Life

Some forms of diabetes can be overturned with timely intervention. Gestational diabetes may vanish after pregnancy is over. Steroid-induced diabetes may improve once you stop taking corticosteroids. Some forms of monogenic diabetes that affect infants may also disappear with time.

However, all such cases may return later in life due to genetic predisposition, negligence, or other factors.

The complications of diabetes are, without a doubt, alarming. However, take this section as a warning on what may happen if you continue to ignore the symptoms. Health is a blessing, and it is better to realise its immense value before you lose it. Timely diagnosis is instrumental in its management. Scroll down to learn more.

Fasting Plasma Glucose or FPG Test

This test is used for the measurement of blood sugar, and the patient must not consume any form of food for 8 hours before the test. This is one of the most commonly used tests for the conclusive diagnosis of diabetes and prediabetes.

The most reliable results are achieved when the test is performed in the morning.

• If the fast-acting glucose level is at 99 mg/dL or below, it indicates normal blood sugar.
• If the fast-acting glucose level falls between 100 and 125 mg/dL, it indicates prediabetes, also called impaired fasting glucose or IFG. It means you do not have diabetes yet, but if proper care and precautions are not taken, you are more likely to develop it.
• If the fast-acting glucose level is at 125 mg/dL or above, it indicates diabetes. The test is then repeated on another day to confirm the diagnosis.

Oral Glucose Tolerance Test or OGTT

This test is regarded as much more precise in the diagnosis of diabetes as compared to FPG. However, despite the increased sensitivity, this test is less convenient to administer. Like FPG, this test also requires the patient to fast for at least 8 hours before administering it. This test can conclusively diagnose diabetes and prediabetes.

The patient consumes a liquid of 75 grams of glucose dissolved in water. The plasma glucose level is measured before and two hours after drinking the fluid.

• If the reading is 139 mg/dL or below, it indicates a completely normal blood sugar level.
• If the reading falls between 140 and 199 mg/dL, it indicates prediabetes, also called impaired fasting glucose or IFG. It means you do not have diabetes yet but are more likely to develop it without proper care.
• If the reading is at 200 mg/dL or above, it indicates diabetes. The test is then repeated on another day to confirm the diagnosis.

A conclusive diagnosis of gestational diabetes is given after performing OGTT. The blood sugar readings are taken at four different intervals. If the results are above the threshold for two readings, that conclusively proves the presence of gestational diabetes.

Random Plasma Glucose Test

This test is one of the standard methods of testing blood sugar levels. The doctor measures your blood sugar level without regard to the timing of your meals.
This test is used in conjunction with analysis of various symptoms to prove the diagnosis of diabetes conclusively. However, this test cannot provide conclusive evidence of prediabetes.

A blood sugar level at 200 mg/dL or above indicates diabetes. The other symptoms that your doctor checks for are;

• Excessive urination
• Excessive thirst and hunger
• Inexplicable weight loss
• Weakness
• Blurred vision
• Slow-healing of sores or wounds

The doctor may also opt for another more accurate testing through FPG or OGTT to confirm diabetes.

Glycated Hemoglobin A1c or HbA1c Test

An HbA1c test does not require the patient to fast. It provides average blood sugar readings for the past two to three months.

This test provides a measurement of the percentage of blood sugar attached to your haemoglobin cells. Haemoglobin refers to the protein in red blood cells that carry oxygen throughout the body.

A high blood sugar level indicates that more sugar is attached to your haemoglobin cells.

• A reading at 5.6% or below is considered normal.
• A reading anywhere between 5.7% and 6.4% indicates prediabetes, also called impaired fasting glucose or IFG. It means you do not have diabetes yet but are more likely to develop it without proper care.
• A reading at 6.5% or above indicates diabetes. The test is repeated and scheduled on another day to confirm the diagnosis.

If the test results are not consistent or you have a condition that makes this test inaccurate (like pregnancy or some form of illness that affects the haemoglobin cells), your doctor may suggest a Random Plasma Glucose Test, FPG, or OGTT for a more conclusive diagnosis.

You have now learned about the different diagnostic tests of diabetes. Next is the most crucial part of this guide. That’s right! The treatments. Please scroll down to learn about them.

Healthy Diet

There are many popular tales and myths of a specific diabetes treatment diet. Please keep in mind that there is no such thing. Scientifically speaking;

• Your diet must contain fruits, vegetables, lean proteins, and whole grains.
• Poultry, fish, olive oil, and nuts are among the healthy foods you can take.
• Your food must be high in nutrition and fibre.
• You must avoid saturated fats, refined carbohydrates, and sweets.
• Avoid eating foods with high fats and calories.

Note: Eating sugary food occasionally is fine, as long as you count them as part of the meal plan

Getting the right balance of protein, fats, and carbohydrates are essential to your health. A dietitian can help you figure out a healthy diet plan that can manage your diabetes.

Exercise

A regular exercise plan is an integral part of the treatment of diabetes, regardless of the type. Exercise helps lower blood sugar. It stimulates the cells and makes them hungry enough to want to absorb the glucose for energy. It also helps increase the body’s sensitivity to insulin, which means you will need much less insulin to help the cells absorb glucose.

• You must choose the activities you enjoy; such as power walks, running, swimming, yoga, aerobics, and more.
• You must make physical activity a regular part of your daily routine.
• Make sure that you do not sit idle in a single place for too long.
• You must engage in half an hour of daily exercise, at least.
• You may also engage in sudden bouts of physically challenging activity for 10 minutes, 3 times a day.
• If you are new to exercising, it is better to go slow in the beginning and pick the pace as your body allows it.

Note: Remember, this disease’s management is less dependent on medication, and more on your will to live a healthy life.

Regular Blood Sugar Testing

Diabetes patients need extremely careful monitoring of the blood sugar level to ensure their health. If you are taking insulin, you may be required to test and record your blood sugar as many as 4 to 10 times a day.

This course of action is recommended for both type 1 and type 2 patients. Even a slight deviation from the average blood sugar can spell trouble for patients with an advanced condition. That’s why regular testing must become a part of the daily routine for a diabetic patient.

You can use a glucose monitor for regular blood sugar testing.

Sometimes, blood sugar levels can change unpredictably despite careful management and monitoring. That’s why you must learn how your blood sugar level responds to food, exercise, medicine, illness, stress, and fluctuations in hormone levels. Your doctor may provide you with detailed information on this subject.

In addition to the regular blood sugar testing, your doctor may also push for an HbA1c test. It is necessary to measure your average blood sugar for the past two to three months. This test shows how well a treatment or management plan is working against diabetes. A higher than expected blood sugar level may indicate the need for a change in the medicine, insulin regime, diet plan, or exercise schedule.

Insulin

People who have type 1 diabetes cannot survive without regular insulin therapy. Additionally, as many as 30% of patients with type 2 and 20% with gestational diabetes may also require regular insulin therapy.

Types of Insulin

A patient with diabetes prescribed with insulin must take it regularly. Avoiding the prescribed dosage may lead to fatal complications within 5-7 days. There are 4 types of insulin you can be prescribed depending upon your condition;

• Rapid-acting insulin that starts working in 15 minutes and lasts for 3-4 hours
• Short-acting insulin that starts working in 30 minutes and lasts for 6-8 hours
• Intermediate-acting insulin that starts working in 1-2 hours and lasts for 12-18 hours
• Long-acting insulin that starts working in a few hours and lasts for 24 hours or longer

Depending on the condition, the doctor may prescribe a mixture of different insulin types that you may use throughout the day and night.

Different Methods of Taking Insulin

You cannot take insulin orally as some of the stomach enzymes may interfere with it. That’s why insulin is usually injected with a syringe or an insulin pen.

Some people prefer the use of insulin pumps. This device is merely the size of a small cellphone. A tube connects the insulin pouch to a catheter that is inserted under your abdominal skin.

The newer models of this device operate wirelessly. It is programmed to dispense a specific amount of insulin at regular intervals. You can also adjust the dosage based on your meal, exercise, and blood sugar level.

How Much Insulin is Too Much?

Insulin is the most important lifeline for a patient with type 1 diabetes. However, too much insulin can lead to harmful complications. The maximum possible dosage varies for each patient and is dependant on insulin sensitivity and several other factors.

Hypoglycemia is a condition that happens when too much insulin is injected into the body. It causes a sharp decrease in the blood sugar level. It can lead to nausea, sweating, shakiness, nervousness, and even unconsciousness.

You must only take the prescribed dosage. The dosage is dependent on a patient’s condition. Follow your doctor’s advice and do not deviate from it.

Medication

Many patients with type 2 diabetes tend to manage their blood sugar levels with exercise and a healthy diet alone. However, several patients use insulin and medication to manage this disease. The medicines for diabetes treatment include;

• Alpha-Glycosidase Inhibitors, such as Acarbose (Glucobay), Miglitol (Glyset) they help slow the breakdown of sugar and starchy food in your stomach
• Biguanides, such as Metformin (Glucophage) they help reduce the amount of glucose produced by your stomach
• DPPP-4 Inhibitors, such as Linagliptin, Saxagliptin (Saxagen), Sitagliptin (Januvia) they help improve the blood sugar level without letting it drop to a critical stage
• GLP1 Agonists, such as Dulaglutide (Trulicity), Exenatide, Liraglutide (Victoza) they help enhance the way your body produces insulin
• Meglitinides, such as Nateglinide (Glytan), Repaglinide (Novonorm) they help stimulate your pancreas, so they release more insulin
• SGL2 Inhibitors, such as Canagliflozin, Dapagliflozin (Dapa) they help release larger quantities of glucose in the urine
• Sulfonylureas, such as Glyburide (DiaBeta, Glynase), Glipizide (Minidiab), Glimepiride (Amaryl) they help stimulate the pancreas, so more insulin is released
• Thiazolidinediones, such as Pioglitazone (Piozer), Rosiglitazone (Escort) they help the body make use of insulin better

Transplant

Some type 1 diabetes patients require a pancreas transplant to switch the faulty one for a fully functioning one. You may no longer need to take artificial insulin if the pancreas transplant is successful.

Transplant operation carries its own risk with it. It is not always a success. Sometimes, the patient requires a lifetime of immunosuppressant drugs to prevent organ rejection. Immunosuppressant drugs have side effects of their own. That’s why transplant is regarded as a high-risk undertaking. It is only reserved for patients whose diabetes cannot be controlled in any other way.

There are ongoing clinical trials for islet cell transplantation. Once approved, this method has a lot of promise in making the lives of diabetic patients easier.

Weight Loss Surgery

Also called bariatric surgery, it is not necessarily a treatment for type 2 diabetes. However, obese people may benefit from it. It is noted that many people who undertake bariatric surgery see an improvement in their blood sugar.

Bariatric surgery changes your digestive system in a way that may help you lose weight.

Some people also undergo liposuction surgery for reducing body fat. However, it is less effective in the management of blood sugar as compared to bariatric surgery.

Herbal Treatment

Diabetes is one of the oldest and most common diseases on earth. Every region and culture has developed different remedies for it. There are claims of several local herbs and spices that can help lower the blood sugar.

Several clinical studies show a potential link between herbal remedies and blood sugar control. This has led to more people using natural herbs and remedies for relief.

The plant-based therapies that have shown anti-diabetic properties during clinical research are;

• Aloe Vera
• Bitter melon
• Garlic
• Bilberry extract
• Cinnamon
• Ginger
• Ginseng
• Okra
• Fenugreek

These extracts are popular in ayurvedic and oriental medicine. However, many western experts remain sceptical about their vaunted medical benefits.

Note: If you decide to use such herbs and remedies, please discuss them with your physician.

Home Remedies

Some treatments or remedies are not part of standard medical care. These alternative treatments are generally steeped in cultural, religious, or regional backgrounds. They might help some patients with blood sugar, nerve damage, or stress resulting from diabetes.

1. Apple Cider Vinegar

   You can consume it directly, with a meal, or a salad. Two tablespoons before bedtime can help reduce the morning fasting blood sugar level. It can also help increase insulin sensitivity.

2. Vegetables

   Fibre-rich food helps reduce blood sugar. The best natural method of taking fibre is through the consumption of vegetables, especially bitter melon.

3. Barley

   Barley has a very high protein and fibre count. It can help improve blood sugar, insulin, cholesterol, and general inflammation.

4. Aloe Vera

   Research suggests that it may help improve blood sugar levels. It may also help in faster healing of the wounds and reducing the swelling.

5. Chromium and Magnesium Rich Food

   Some studies have shown links between diabetes and micronutrients deficiency, such as chromium, magnesium, and zinc. You can eat egg-yolk, whole-grain products, coffee, broccoli, and meat for chromium deficiency. Similarly, you can take green leaf products, fish, bananas, and beans for magnesium.

You can also take these necessary minerals as medical supplements.

Cinnamon Extract

Cinnamon has shown to improve insulin sensitivity on a cellular level. It can help reduce blood sugar by a significant margin.

Berberine

This Chinese herb has been used for the treatment of diabetes for thousands of years. Some researchers regard it as one of the most critical supplements for diabetes and prediabetes.

You will be now feeling more confident and qualified enough to manage your own or a loved ones’ diabetes. However, keep in mind that when it comes to this disease, it is always better to prevent it from occurring in the first place. This is how you do it!

Exercise

Daily physical workouts may be the biggest factor that can help prevent diabetes.
Exercise makes the cells more insulin sensitive. This helps them absorb more glucose from your body for lesser effort. It can halt the progression of prediabetes to diabetes. It can even help reverse a mild enough condition.

According to a study;

• A moderately intense workout increases insulin sensitivity by 48%.
• A highly intense workout increases insulin sensitivity by 85%.

To achieve these benefits, you must burn more than 2000 calories per week via exercise.

Lose Weight

Not everyone who develops type 2 diabetes is overweight. However, more than 85% of patients with diabetes and prediabetes are obese.

Studies show that even losing small amounts of weight can be of immense help in preventing or managing diabetes. According to a study, losing 1kg weight can help reduce the risk of developing diabetes by 16%.

Eat Less Sugar and Refined Carbs

Sugary foods and refined carbs significantly increase the risk of diabetes. Sweets, white rice, white bread, baked potatoes, mashed potatoes, chips, sugary cereals, biscuits, cakes, energy bars, etc.; all of them are fast releasing carbohydrates.

These foods can contribute to a gradual increase in blood sugar and insulin levels. The situation may eventually turn into type 2 diabetes.

Drink Water and Avoid Artificial Beverages

Water is the most natural and healthy beverage you can find. It is an excellent alternative to artificial beverages.

Sugar rich beverages are high in preservatives and other questionable ingredients. They are linked to the increasing rate of type 2 diabetes, prediabetes, double diabetes in the young generation by 26%.

According to a study, the risk for adult-onset type 1 diabetes increases by 99% due to their consumption.

A few studies show that increasing water consumption may help in controlling blood sugar and insulin response.

Quit Smoking

Smoking not only contributes to diabetes, it also increases the risk of heart disease, breathing disorders, and many forms of cancer. Research suggests that even secondhand smoke can increase the risk of type 2 diabetes.

According to a study, the risk of diabetes increases by 45% in average smokers and 61% in people who smoke more than 20 cigarettes a day.

Some people may gain weight after quitting smoking. Regardless of this, the overall risk of diabetes remains significantly lower than if they had never stopped smoking.

Eat Low-Carb and High-Fibre Diet

Low carb and high fibre diets help reduce weight, blood sugar, and insulin. They also help increase insulin sensitivity.

According to a study, the blood sugar drops by 12% and insulin level by 50% in a prediabetic individual if they consume low-carb food for up to 12 weeks.

Similarly, high fibre food is very good for gut health and weight management. Most unprocessed plant-based food products contain high fibre content.

Avoiding Inactivity

Very little or no physical activity for a large portion of the day can increase the risk of diabetes. Simple acts like standing up and walking around for a few minutes once an hour can help decrease the risk.

According to a study, people who spend the largest amount of time remaining inactive have a 112% more chance of developing diabetes.

Avoid Processed Food

Processed foods are linked to all kinds of health problems; such as heart disorders, digestive disorders, obesity, etc. According to a study, the risk for diabetes increases by 15% from processed foods’ consumption.

Drink Tea or Coffee

Water should be your primary beverage. However, three cups of regular tea, green tea, or coffee may help reduce the risk of diabetes by 42%. These drinks contain antioxidants called EGCG that help lower blood sugar and increase insulin sensitivity.

Consume Natural Herbs

Consumption of some natural herbs can be very helpful in managing blood sugar and increasing insulin sensitivity. The most used and scientifically approved herbal products are;

• Turmeric
• Berberine

Note: Please inform your doctor before initiating a regular use of these herbal products or others.

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