Understanding Diabetes: Types, Symptoms and Treatment

Diabetes is a chronic condition has reached epidemic proportions in the U.S., affecting more than 38 million adults, or about 11 percent of the population. The number of adults diagnosed with diabetes has more than doubled over the last 20 years, with 1.2 million Americans diagnosed annually. Whether you have been diagnosed with diabetes or not, it’s important to understand diabetes types, symptoms and treatment.

“Diabetes is considered a chronic and lifelong condition with potentially devastating consequences,” said John Sherrill, MD, an internal medicine physician at Crossville Medical Group who specializes in diabetes treatment. “The most concerning risks are early disability and death resulting from the cascade of illnesses caused or worsened by type 2 diabetes.”

While diabetes can be managed with medications and/or lifestyle changes, many individuals – one in five – don’t know they have it. Awareness of symptoms, screenings, and treatment options is key to preventing and managing the disease. “With excellent management, you can actually reverse type 2 diabetes and put it into remission,” said Dr. Sherrill.

What is Diabetes?  

Insulin is a hormone that acts like a key to let glucose (blood sugar) enter our cells to be used for energy. Glucose is derived from carbohydrates in food and drinks and is the body’s main energy source. When you have diabetes, your pancreas doesn’t make enough insulin, or your body doesn’t use insulin properly.

If glucose can’t enter cells, it builds up in the bloodstream, causing hyperglycemia, or high blood sugar. Over time, consistently high blood glucose can lead to health issues such as heart disease, kidney damage, nerve damage and eye issues.

Understanding Diabetes Types 

Diabetes, technically diabetes mellitus, is a complicated condition with a range of types and treatment approaches. The three officially classified types are Type 1, Type 2, and Gestational. Type 2 diabetes (TD2) is the most common form, accounting for about 90 percent of all diagnosed cases. Type 1 diabetes (TD1) accounts for about 10 percent of cases. Gestational diabetes (GD) occurs in 8-10 percent of pregnant women and develops from hormonal imbalance that leads to insulin resistance.

Type 1 Diabetes 

Type 1 diabetes typically develops in children (ages 4-6), early puberty (ages 10-14), and young adults, but it can be diagnosed at any age. Once known as insulin-dependent or juvenile diabetes, TD1 is an autoimmune disease that occurs when the immune system attacks and destroys insulin-producing cells in the pancreas, stopping or severely limiting insulin production.

Symptoms can develop quickly and may include fruity-smelling breath, nausea and vomiting, stomach pain, rapid breathing, confusion, drowsiness, and loss of consciousness. Risk factors include having a family member such as a parent or sibling with type 1 diabetes. If untreated, type 1 diabetes can be life-threatening.

Is There a Type 1.5 Diabetes?

Type 1.5 diabetes, also called Latent Autoimmune Diabetes in Adults (LADA), straddles types 1 and 2. While not yet classified as an official type, researchers continue to study its symptoms and treatment options.

Type 2 Diabetes 

The most common form of diabetes, type 2, is a chronic condition typically diagnosed among adults older than 45. With TD2, the body doesn’t make enough insulin, or cells don’t respond to insulin as they should. The pancreas increases insulin production to manage increasing blood sugar levels (hyperinsulinemia). Type 2 develops when the pancreas can’t produce enough insulin to overcome insulin resistance.

Healthy blood sugar (glucose) levels are 70 to 99 milligrams per deciliter (mg/dL). With untreated type 2, levels are typically 126 mg/dL or higher. Lifestyle factors contribute to the development of type 2 and include obesity, lack of physical activity, diet, hormonal imbalances, genetics, and certain medications.

“Highly processed foods high in carbs and saturated fats cause us to eat and store more fat in our bodies,” said Dr. Sherrill. “Without intervention, these factors set the stage for insulin resistance and eventually TD2.”

Type 1 vs. Type 2 Diabetes 

In all its forms, diabetes results from too much glucose in the bloodstream. The reason for elevated glucose levels, however, differs depending on the type of diabetes. Type 1 diabetes is an autoimmune disease in which the immune system attacks insulin-producing cells in your pancreas for unknown reasons. Symptoms can develop in just a few weeks or months and can be severe. Individuals with type 1 always need insulin to manage the condition.

Type 2 develops when your body doesn’t make enough insulin or your cells become insulin-resistant. Symptoms may take years to develop. The condition can often be managed with lifestyle changes, oral medication, and/or insulin.

Type 2 diabetes typically affects older adults but is becoming more prevalent among young people. The incidence of youth-onset type 2 diabetes has increased along with the rise in the number of children with obesity. In Tennessee, childhood obesity rates have risen from 5 percent to approximately 45 percent over the past 40 years. Without intervention, it’s projected that two-thirds of the population will have prediabetes or diabetes by 2050.

Dr. Sherrill advocates an aggressive approach to battling diabetes. “Sugar can be an addiction just like any other addictive substance. Individuals with this disease progression can’t simply cut back to see desired outcomes. Those who succeed do so by completely cutting out certain foods, adding protein, monitoring glucose, and building exercise into daily routines.”

Is There a Type 3c Diabetes? 

Type 3c diabetes occurs when the pancreas is damaged and its ability to produce insulin is affected. This can occur from pancreatitis, pancreatic cancer, cystic fibrosis, hemochromatosis, or a pancreatectomy. Some individuals with Type 3c take oral diabetes medications; others need insulin to manage the condition.

Gestational Diabetes 

Gestational diabetes occurs during pregnancy when hormones from the placenta block a mother’s ability to make or use insulin. Between 24 and 28 weeks of pregnancy, OB-GYNs test for GD by performing a glucose tolerance test. They follow up with additional testing if sugar levels are too high. Gestational diabetes usually goes away after the baby is born but can sometimes lead to additional health problems in the mother or baby.

Other Diabetes Types

Brittle diabetes is a form of Type 1 diabetes that describes difficult-to-manage diabetes. The condition is marked by frequent and severe glucose swings that are difficult to predict. Brittle diabetes is typically associated with other physical and/or mental health conditions, aging and memory loss, lack of access to insulin and food insecurity.

Maturity-onset diabetes of the young (MODY), also called monogenic diabetes, is caused by a genetic mutation that affects how the body makes and uses insulin. There are currently 10+ different types of MODY, which affects up to 5 percent of people with diabetes.

Pre-Diabetes

Prediabetes is a stage when blood sugar levels are higher than normal but not high enough for a diabetes diagnosis. More than 1 in 3 American adults are living with prediabetes. Over 70 percent of people with prediabetes later develop type 2 diabetes. Because many do not experience symptoms, regular health screenings are important to catch prediabetes early and help prevent or delay the onset of type 2 diabetes.

Understanding Diabetes Symptoms

Without enough insulin, the body begins to break down fat as fuel. This causes a buildup of acids in the bloodstream called ketones. If left untreated, the buildup can lead to diabetic ketoacidosis. Symptoms can come on quickly and may be the first sign of type 1 diabetes for those who have not been diagnosed. If type 1 is suspected, your doctor may test your urine for ketones produced when your body burns fat for energy; your blood may be tested for antibodies that indicate an autoimmune response.

Type 2 assessment tests are also available to help gauge risk factors. Talk with your doctor about testing if you experience the following risk factors:

• Frequent urination, often at night
• Extreme thirst
• Weight loss without trying
• Extreme hunger
• Blurry vision
• Numb or tingling hands or feet
• Fatigue
• Very dry skin
• Sores that heal slowly
• More infections than usual

Can You Prevent Diabetes? 

While not all diabetes can be prevented, lifestyle changes can help lower your risk for developing type 2, delay its onset, and even reverse prediabetes. These practices can help: :

• Exercising at least 150 minutes per week
• Maintaining a healthy weight
• Eating nutritious food
• Managing stress levels
• Not smoking

“The most important first steps in treating diabetes are abstaining from liquid sugars and reducing processed convenience foods,” said Dr. Sherrill. He also advises learning to love water, building strategies around cooking and eating at home, and following other nutrition tips for diabetes. 

Understanding Diabetes Treatment 

Diabetes treatment includes managing your diet, monitoring blood sugar, and taking insulin/medication. Lifestyle changes such as healthy food choices and exercise also help, and reduce the risk for diabetes-related health complications.

“Keys to preventing the onset of TD2 are eating basic, real food and moving your body daily with routines like taking a walk after supper,” says Dr. Sherrill.

Weight-loss-promoting medicines such as GLPs and SGLT2s can also help manage diabetes. To track your progress and manage your medications, be sure to maintain regular check-ups with your healthcare team.

Type 1 Treatment 

Type 1 diabetes can be managed effectively by monitoring blood glucose, counting carbs, and taking insulin. Blood sugar can be monitored regularly throughout the day. Your doctor will advise how often to check it and what your target blood sugar levels should be.

One method for checking blood sugar uses a blood glucose meter. To use the meter, you prick your finger and put a small drop of blood on the test strip. Within seconds, your blood glucose level appears on the meter, showing your blood sugar at the time of the check.

Continuous glucose monitoring (CGM) is a more advanced way of checking blood sugar. It uses a small sensor placed just under the skin to record blood glucose levels continuously, giving 24/7 tracking of levels.  

A significant part of managing diabetes is counting the carbohydrates in your food and drinks. When you digest carbohydrates, your body converts them into glucose, raising blood sugar. With type 1 diabetes, you give yourself insulin doses to account for the carbohydrates you consume.

The daily dosage of insulin depends on several factors, including weight, age, activity level, food intake, and blood sugar level. Insulin can’t be taken as a pill because acid in the stomach would destroy it before it enters the bloodstream. Insulin must be injected under the skin. Your healthcare provider will help determine your insulin-to-carb ratio and your method for receiving insulin. Options may include injections, pens, pumps and inhalers.

Type 2 Treatment 

Treatment for type 2 diabetes involves exercise, eating right, and maintaining a healthy weight. Some people may also need medication. Exercise helps lower your blood sugar, and the general goal is to get at least 150 minutes of moderate-intensity physical activity per week.

“Insulin isn’t as effective for those with type 2 diabetes, as the tissue is essentially ‘stuffed’ with carbohydrates in the form of glycogen and fat,” said Dr. Sherrill. “Early and aggressive intervention through diet changes can be extremely effective in treating type 2 and its symptoms.”

Your diet should include a healthy balance of lean proteins, non-starchy vegetables, healthy fats, and complex carbohydrates. Blood sugar monitoring can help by providing real-time information about your glucose levels.

Oral diabetes medications can be used to help manage blood sugar levels for some with T2D. The most common is metformin. Injectable medications, such as GLP-1 and dual GLP-1/GIP agonists, may also be used to manage glucose levels and obesity. In some cases of TD2, insulin may be used to lower blood sugar levels.

Gestational Treatment 

Women with gestational diabetes typically receive treatment from their pregnancy care providers. They may visit a nutritionist or dietician to discuss recommendations for healthy meals, snacks, and foods to avoid. They also learn their desired blood sugar levels and how to check their levels at home.  

If you have GD, your provider may schedule more prenatal visits to check fetal growth, monitor weight gain and review your blood sugar. Because GD increases the risk for type 2, you’ll need to be tested for TD2 every three years after your pregnancy.

What Medical Specialties Treat Diabetes?  

Many health issues related to diabetes are the result of damage to tiny blood vessels in the eyes (diabetic retinopathy), nerves (diabetic neuropathy), and kidneys (diabetic nephropathy). People with diabetes also have a higher risk of heart disease and stroke. Because of this, your care team may include medical guidance and support from a variety of specialties, including:

• Primary care physician (PCP)
• Endocrinologist
• Registered dietitian
• Certified diabetes care and education specialist (CDCES)
• Ophthalmologist (eye doctor)
• Dentist

Your primary care provider is the first line of defense in diagnosing and managing diabetes symptoms. Your doctor may use a test called random plasma glucose (RPG) to check your blood sugar. You may also receive an A1C blood test to estimate blood sugar levels over the last three months, to show how well your blood sugar is controlled.

Endocrinologists treat conditions related to hormones, diagnosing and developing treatment plans for metabolic conditions like diabetes. Regular visits to an endocrinologist can ensure that insulin dosages and diabetes management strategy are working effectively.

Living with diabetes requires constant care that can be overwhelming. Your care team will offer support and provide resources to help manage your condition. If you have been diagnosed or wonder if you have symptoms of diabetes, visit our website to locate a provider near you.