Diabetes (Type 1, 2, and Gestational)

Diabetes (Type 1, 2, and Gestational)

What is type 1 diabetes?

Type 1 diabetes may also be known by a variety of other names, including the following:

There are two forms of type 1 diabetes:

Immune-mediated diabetes is the most common form of type 1 diabetes, and the one generally referred to as type 1 diabetes. The information on this page refers to this form of type 1 diabetes.

Type 1 diabetes accounts for 5 to 10 percent of all diagnosed cases of diabetes in the U.S. Type 1 diabetes usually develops in children or young adults, but can start at any age.

What causes type 1 diabetes?

The cause of type 1 diabetes is unknown, but it is believed that genetic and environmental factors (possibly viruses) may be involved. The body's immune system attacks and destroys the insulin producing cells in the pancreas. Insulin allows glucose to enter the cells of the body to provide energy.

When glucose cannot enter the cells, it builds up in the blood, depriving the cells of nutrition. People with type 1 diabetes must take daily insulin injections and regularly monitor their blood sugar levels.

What are the symptoms of type 1 diabetes?

Type 1 diabetes often appears suddenly. The following are the most common symptoms of type 1 diabetes. However, each individual may experience symptoms differently. Symptoms may include:

In children, symptoms may be similar to those of having the flu.

The symptoms of type 1 diabetes may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

What complications may be associated with type 1 diabetes?

Type 1 diabetes can cause many different problems. However, the three key complications of diabetes include the following:

  1. Hypoglycemia. Low blood sugar; sometimes called an insulin reaction; occurs when blood sugar drops too low.
  2. Hyperglycemia. High blood sugar; occurs when blood sugar is too high, and can be a sign that diabetes is not well controlled.
  3. Ketoacidosis. High blood sugars and build up of acids in the blood due to untreated or under-treated diabetes.
Diabetes Control and Complications Trial

The Diabetes Control and Complications Trial, a landmark 10-year study, demonstrated that people who lowered their blood glucose concentration have a better chance of delaying or preventing diabetes complications that affect the eyes (retinopathy), kidneys (nephropathy), and nerves (neuropathy). Two groups of patients with type 1 diabetes were studied: one group followed a standard treatment regimen and the other group followed an intensive treatment regimen. People who lowered their blood glucose levels practiced the intensive treatment regimens that included careful self-monitoring of glucose, multiple daily insulin injections, and close doctor contact.

What is the treatment for type 1 diabetes?

Specific treatment for type 1 diabetes will be determined by your doctor based on:

People with type 1 diabetes must have daily injections of insulin to keep their blood sugar level within normal ranges. Other parts of the treatment protocol may include:

The hemoglobin A1c test (also called HbA1c test) shows the average amount of sugar in the blood over the last three months. The result will indicate if the blood sugar level is under control. The frequency of HbA1c testing will be determined by your doctor. The American Diabetes Association (ADA) recommends that testing occur at least twice a year if the blood sugar level is in the target range and stable, and more frequently if the blood sugar level is unstable.

Advances in diabetes research have led to improved methods of managing diabetes and treating its complications. However, scientists continue to explore the causes of diabetes and ways to prevent and treat the disorder. Other methods of administering insulin through inhalers and pills are currently being studied. Scientists are investigating gene involvement in type 1 and type 2 diabetes, and some genetic markers for type 1 diabetes have been identified. Pancreas and islet cell transplants are also being performed.

What is type 2 diabetes?

Type 2 diabetes is a metabolic disorder resulting from the body's inability to make enough, or to properly use, insulin. It used to be called non-insulin-dependent diabetes mellitus (NIDDM).

Without adequate production or utilization of insulin, the body cannot move blood sugar into the cells. It is a chronic disease that has no known cure. It is the most common type of diabetes.

What is prediabetes?

Type 2 diabetes is commonly preceded by prediabetes. In prediabetes, blood glucose levels are higher than normal but not high enough to be defined as diabetes. However, many people with prediabetes develop type 2 diabetes within 10 years, states the National Institute of Diabetes and Digestive and Kidney Diseases. Prediabetes also increases the risk of heart disease and stroke. With modest weight loss and moderate physical activity, people with prediabetes can delay or prevent type 2 diabetes.

Prediabetes affects 79 million people in the US, according to the American Diabetes Association (ADA).

What causes type 2 diabetes?

The exact cause of type 2 diabetes is unknown. However, there does appear to be a genetic factor which causes it to run in families. Although a person can inherit a tendency to develop type 2 diabetes, it usually takes another factor, such as obesity or physical inactivity, to bring on the disease.

Can type 2 diabetes be prevented or delayed? 

Type 2 diabetes may be prevented or delayed by following a program to eliminate or reduce risk factors--particularly losing weight and increasing exercise. Information gathered by the Diabetes Prevention Program, sponsored by the National Institutes of Health and the ADA, continues to study this possibility.

What are the symptoms of type 2 diabetes?

The following are the most common symptoms of type 2 diabetes. However, each individual may experience symptoms differently. Symptoms may include:

Some people who have type 2 diabetes exhibit no symptoms. Symptoms may be mild and almost unnoticeable, or easy to confuse with signs of aging. Half of all Americans who have diabetes do not know it.

The symptoms of type 2 diabetes may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

What are the risk factors for type 2 diabetes?

Risk factors for type 2 diabetes include the following:

What is the treatment for type 2 diabetes?

Specific treatment for type 2 diabetes will be determined by your doctor based on:

United Kingdom Prospective Diabetes Study

The United Kingdom Prospective Diabetes Study, the longest and largest study of people with type 2 diabetes completed in Europe in 1998, demonstrated that intensive control of glucose and blood pressure in these people reduced the risk of kidney disease, blindness, stroke, and heart attack.

The goal of treatment is to keep blood sugar levels as close to normal as possible. Emphasis is on control of blood sugar (glucose) by monitoring the levels, regular physical activity, meal planning, and routine health care. Treatment of diabetes is an ongoing process of management and education that includes not only the person with diabetes, but also health care professionals and family members.

Often, type 2 diabetes can be controlled through losing weight, improved nutrition, and exercise alone. However, in some cases, these measures are not enough and either oral medications and/or insulin must be used. Treatment often includes:

Untreated or inappropriately-treated diabetes can cause problems with the kidneys, legs, feet, eyes, heart, nerves, and blood flow, which could lead to kidney failure, gangrene, amputation, blindness, or stroke. For these reasons, it is important to follow a strict treatment plan.

What is gestational diabetes?

Gestational diabetes is a condition in which the glucose level is elevated and other diabetic symptoms appear during pregnancy in a woman who has not previously been diagnosed with diabetes. All diabetic symptoms disappear following delivery.

Unlike type 1 diabetes, gestational diabetes is not caused by a lack of insulin, but rather by the effects of hormones released during pregnancy on the insulin that is produced, a condition referred to as insulin resistance.

According to the ADA, approximately 4 to 8 percent of all pregnant women in the U.S. are diagnosed with gestational diabetes.

What causes gestational diabetes mellitus (GDM)?

Although the cause of GDM is not known, there are some theories as to why the condition occurs.

The placenta supplies a growing fetus with nutrients and water, and also produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can block the effects of insulin. This is called contra-insulin effect, which usually begins about 20 to 24 weeks into the pregnancy.

As the placenta grows, more of these hormones are produced, and insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.

What are the risks factors associated with gestational diabetes?

Although any woman can develop gestational diabetes during pregnancy, some of the factors that may increase the risk include the following:

Although increased glucose in the urine is often included in the list of risk factors, it is not believed to be a reliable indicator for GDM.

How is GDM diagnosed?

New Standards of Medical Care in Diabetes-2011 from the ADA recommend screening for undiagnosed type 2 diabetes at the first prenatal visit in women with diabetes risk factors. In pregnant women not known to have diabetes, GDM testing should be performed at 24 to 28 weeks of gestation.

In addition, women with diagnosed GDM should be screened for persistent diabetes six to 12 weeks postpartum. Women with a history of GDM are now recommended to have lifelong screening for the development of diabetes or prediabetes at least every three years.

What is the treatment for gestational diabetes?

Specific treatment for gestational diabetes will be determined by your doctor based on:

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

What are possible complications for the baby?

Unlike type 1 diabetes, gestational diabetes generally does not cause birth defects. Birth defects usually originate sometime during the first trimester (before the 13th week) of pregnancy. The insulin resistance from the contra-insulin hormones produced by the placenta does not usually occur until approximately the 24th week. Women with gestational diabetes generally have normal blood sugar levels during the critical first trimester.

The complications of gestational diabetes are usually manageable and preventable. The key to prevention is careful control of blood sugar levels just as soon as the diagnosis of gestational diabetes is made.

Infants of mothers with gestational diabetes are vulnerable to several chemical imbalances, such as low serum calcium and low serum magnesium levels, but, in general, there are two major problems of gestational diabetes: macrosomia and hypoglycemia.

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