Resources for People with Diabetes

Having diabetes means many life changes. These changes may seem overwhelming. That’s a normal feeling. When you feel down, reach out to your family and friends. Your healthcare team is also there when you have questions or need advice.

What is type 1 diabetes?

In type 1 diabetes, the body can’t make insulin. Insulin is needed to help sugar (glucose) enter cells for energy. Without insulin, glucose builds up in the blood. This causes high blood glucose or high blood sugar. In the past, type 1 diabetes was also called:

• Insulin-dependent diabetes mellitus (IDDM)
• Juvenile diabetes
• Brittle diabetes
• Sugar diabetes

Type 1 diabetes accounts for between 5 out of 100 to 10 out of 100 diagnosed cases of diabetes in the U.S. Type 1 diabetes most often develops in children or young adults. But it can start at any age.

What causes type 1 diabetes?

Experts don't know what causes type 1 diabetes. Genetic and environmental factors may play a role.

The body's immune system attacks and destroys the cells in the pancreas that make insulin. Insulin lets glucose enter the cells for energy. When glucose can’t enter the cells, it builds up in the blood. Then the cells don't get enough nutrition. It also causes high blood sugar. People with type 1 diabetes must check their blood sugar levels regularly and take daily insulin shots or wear a pump that continually injects insulin.

The FDA approved a new medicine to help delay the onset of type 1 diabetes. This may be an option for people ages 8 and older who are at high risk or have early signs of type 1 diabetes.

What are the symptoms of type 1 diabetes?

Type 1 diabetes often appears suddenly. Symptoms may include:

• Abnormal thirst
• Frequent and increased urination
• Extreme hunger but loss of weight
• Blurred vision
• Nausea and vomiting
• Extreme weakness and lack of energy (fatigue)
• Irritability and mood changes
• Fungal (yeast) skin infections in the groin area

In children, symptoms may seem like the flu. Bedwetting may be an important sign.

These symptoms may be caused by other conditions or health problems, including some medicines. Always see your healthcare provider for a diagnosis.

How is type 1 diabetes diagnosed?

There are several ways to diagnose diabetes. It's usually best for the tests to be repeated on a second day to make sure of the diagnosis.

• Fasting plasma glucose (FPG). This test checks your blood glucose levels after having no calorie intake for at least 8 hours. You may have water before this test is done, but nothing else. Diabetes is diagnosed at a fasting blood glucose level of 126 mg/dL or higher.
• Oral glucose tolerance test (OGTT). This is a 2-hour test that checks your blood glucose levels before and 2 hours after you drink a sugary drink. This test tells your healthcare provider how your body processes glucose. Diabetes is diagnosed at a 2-hour blood glucose of 200 mg/dL or higher. If this test is used for screening, be sure you have at least 5.25 ounces (150 grams) of carbohydrates per day for 3 days before the test.
• A1C. The hemoglobin A1C test measures your average blood glucose for the past 2 to 3 months. Diabetes is diagnosed at an A1C of 6.5% or higher.
• Random glucose test. This blood test is done at any time of the day. Diabetes is diagnosed at blood glucose of 200 mg/dL or higher with the symptoms of hyperglycemia or hyperglycemic crisis.
• Insulin and c-peptide levels. Levels of these will be low or normal with type 1 diabetes but high with type 2 diabetes.
• Antibody levels. People with newly diagnosed type 1 diabetes will often have high levels of antibodies against certain proteins found in the pancreas.

How is type 1 diabetes treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

If you have type 1 diabetes, you will need daily shots of insulin to keep your blood sugar level in normal ranges. Other parts of treatment may include:

• Eating a diet to help manage blood sugar levels
• Exercising to help the body use blood sugar efficiently
• Monitoring blood sugar levels by fingerstick testing several times a day or by continuous monitoring, as directed by your healthcare provider, and learning how to adjust your meals and insulin dose as needed
• Having regular hemoglobin A1C testing. This is advised at least 2 times a year. You may need to do this more often if your blood sugar level stays too high.

Research is being done to find better ways to manage diabetes. This includes looking for other ways to take insulin such as through pens, inhalers, pills, or pumps. Researchers have also found some genetic markers for type 1 diabetes. Pancreas and islet cell transplants are considered experimental treatments.

What are possible complications of type 1 diabetes?

Type 1 diabetes may cause:

• Hypoglycemia. This is low blood sugar, sometimes called an insulin reaction. It occurs when blood sugar drops below 70 mg/dL. This can happen if the last insulin dose was too high for the amount of food eaten.
• Hyperglycemia. This is high blood sugar that occurs when the body has too little insulin. It can be a sign that diabetes is not well controlled.
• Ketoacidosis. When your body doesn't have enough insulin to use glucose for energy, the liver creates ketones out of fat. These ketones are then sent out in the bloodstream to muscles and other tissues to be used for energy. This can be part of the normal body function. But with diabetes, ketones can build up to high levels and become a life-threatening condition, leading to coma or death.

Long-term complications of uncontrolled type 1 diabetes include:

• Heart disease
• Kidney disease
• Eye problems
• Nerve problems
• Foot problems

Key points about type 1 diabetes

• In type 1 diabetes, the body can’t make insulin.
• It is an immune system disorder. The body's immune system destroys, or tries to destroy, the cells in the pancreas that make insulin.
• It most often develops in children or young adults. But it can start at any age.
• It often appears suddenly. Symptoms include abnormal thirst, frequent urination, blurred vision, nausea, and vomiting.
• For type 1 diabetes, you need daily insulin, either by injections or a pump that continuously delivers it under the skin. You also need to regularly check your blood sugar levels.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions, especially after office hours and on weekends and holidays.

Type 2 Diabetes

What is gestational diabetes?

Gestational diabetes is a type of diabetes that happens during pregnancy. Unlike type 1 diabetes, gestational diabetes is not caused by having too little insulin. Instead, hormones made by your placenta keep your body from using insulin as it should. This is called insulin resistance. Blood sugar (glucose) then builds up in your blood instead of being absorbed by the cells in your body.

The symptoms of gestational diabetes often go away after delivery. But sometimes they don't. Or you may have a greater risk of developing type 2 diabetes later.

What causes gestational diabetes?

Healthcare providers don't know what causes gestational diabetes. But they do know what happens.

The placenta gives your growing baby nutrients and water. The placenta also makes several hormones to keep the pregnancy healthy. These hormones include:

• Estrogen
• Progesterone
• Cortisol
• Human placental lactogen

These hormones can affect how your body uses insulin (contra-insulin effect). This often begins about 20 to 24 weeks into your pregnancy and could lead to gestational diabetes.

During pregnancy, more fat is stored in your body, you take in more calories, and you may get less exercise. All of these things can make your blood sugar (glucose) levels higher than normal and possibly lead to gestational diabetes.

As the placenta grows, it makes more of the hormones. The risk for insulin resistance becomes greater. Normally your pancreas is able to make more insulin to overcome insulin resistance. But if it can't make enough to overcome the effects of the placenta’s hormones, you can develop gestational diabetes.

Who is at risk for gestational diabetes?

Any person can develop gestational diabetes during pregnancy. But you may be more likely to get it if you:

• Are overweight or obese
• Have a family history of diabetes
• Are older than 40
• Are African American, American Indian, Asian American, Hispanic or Latino, or Pacific Islander
• Have prediabetes (impaired glucose tolerance) or another condition that makes it more likely for you to have diabetes, such as polycystic ovarian syndrome
• Have high blood pressure
• Had gestational diabetes during a past pregnancy

What are the symptoms of gestational diabetes?

Gestational diabetes doesn't cause any symptoms. That’s why it’s important to get tested for it if you are at high risk.

If your blood sugar levels are very high, you may have these symptoms:

• You pee more than normal.
• You are hungrier or thirstier than normal.
• You have blurred vision.
• You have nausea and vomiting.
• You lose weight even though you are hungrier.

How is gestational diabetes diagnosed?

You should be tested for gestational diabetes in your 24th to 28th week of pregnancy.

The American Diabetes Association also advises that you be tested for type 2 diabetes if you have risk factors for this condition. This testing should be done at your first prenatal visit.

Screening is done by these tests:

• 1-hour glucose tolerance test. You drink a special beverage high in sugar. One hour later, the healthcare provider measures your blood sugar (glucose) levels. If your levels are higher than a certain level, this is considered an abnormal result.
• 3-hour glucose tolerance test. If the 1-hour test is abnormal, you will have a second glucose tolerance test done to confirm the diagnosis. You will drink another special beverage, but with more sugar. Your healthcare provider will measure your blood sugar levels 1 hour, 2 hours, and 3 hours later. You have gestational diabetes if at least two of the glucose measurements are higher than normal.

If you are diagnosed with gestational diabetes, you should get tested for diabetes 4 to 12 weeks after your baby is born. You should also get this screening at least every 1 to 3 years for the rest of your life.

What is the treatment for gestational diabetes?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment for gestational diabetes focuses on keeping your blood sugar levels in the normal range. Treatment may include:

• Special diet. You will meet with a registered dietitian (RD) to develop an individualized diet based on based on medical, lifestyle, and personal factors. Some general guidelines include eating vegetables, low-fat or nonfat dairy products, and protein such as lean meats, nuts, and seeds. Use healthy fats, like olive or canola oil. You should eat whole grains and avoid high-calorie snacks, sweet drinks, and sweet desserts. Limit fruit servings to a small piece of fruit or approximately 1 cup at a time.
• Exercise. You should do moderate exercise unless your healthcare provider tells you not to.
• Daily blood glucose monitoring. Your goals are to keep your fasting blood sugar level lower than 95 mg/dL, and your after eating (postprandial) blood sugar lower than 140 mg/dL 1 hour after eating or lower than 120 mg/dL 2 hours after eating.
• Insulin injections. You may need these to control your blood sugar levels. Or you may need other medicines taken by mouth.

What are possible complications of gestational diabetes?

Gestational diabetes usually doesn't cause birth defects. But it can affect your baby in other ways if your blood sugar levels are not under control.

Below are the 2 major health problems that can develop.

Key points about gestational diabetes

• Gestational diabetes is a type of diabetes that happens during pregnancy.
• It may be caused by the hormones made by your placenta. These hormones can make insulin in your body not work as well as it should.
• Gestational diabetes happens about halfway through pregnancy and doesn't usually cause birth defects.
• If your blood sugar is not under control, your baby can develop problems. One problem is larger growth than normal. The other problem is very low blood sugar just after birth.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are and when they should be reported.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.