Comprehensive Guide to Diabetes

• Type 1 Diabetes: An autoimmune condition where the immune system attacks insulin-producing beta cells in the pancreas. This results in little to no insulin production, necessitating lifelong insulin therapy.
• Type 2 Diabetes: A condition characterized by insulin resistance and relative insulin deficiency. It is often associated with obesity, sedentary lifestyles, and genetic predisposition.
• Gestational Diabetes: This occurs during pregnancy when hormonal changes lead to insulin resistance. While it typically resolves postpartum, it increases the risk of developing type 2 diabetes later in life.
• Type 1.5 Diabetes: Also known as latent autoimmune diabetes in adults (LADA), this condition occurs in adulthood and progresses gradually. It is an autoimmune disease and often misdiagnosed as type 2 diabetes but requires insulin therapy.
• Prediabetes: A condition where blood sugar levels are higher than normal but not high enough for a diabetes diagnosis. Prediabetes can lead to type 2 diabetes without lifestyle modifications.

A rare condition called diabetes insipidus, unrelated to diabetes mellitus, occurs when the kidneys remove excessive fluid from the body, leading to dehydration and other issues.

Risk Factors for Diabetes

A variety of factors contribute to an individual’s risk of developing diabetes, influencing the likelihood of complications and the management of the condition.

General Risk Factors

Gender: Men are generally more likely to have diabetes than women. However, socioeconomic factors, such as income, education level, and employment status, impact diabetes rates differently among men and women.

Socioeconomic Disadvantage: Populations with lower socioeconomic status are at higher risk due to contributing factors like:

• Obesity
• Cigarette smoking
• High blood pressure
  
  

Prediabetes

You’re at a higher risk of developing prediabetes if you have:

• Abdominal obesity
• A family history of type 2 diabetes

Taking steps to lower your risk and manage blood glucose levels can help prevent or delay the onset of type 2 diabetes.

Type 1 Diabetes

The risk factors for type 1 diabetes are not fully understood but may include:

• Age
• Genetics
• Environmental factors

Type 1 and 1.5 diabetes is not preventable.

Type 2 Diabetes

Several risk factors contribute to type 2 diabetes, including (Diabetes Risk Factors – CDC):

• Prediabetes
• Advanced age
• High cholesterol
• Physical inactivity
• High blood pressure
• Overweight or obesity
• A history of gestational diabetes
• A family history of type 2 diabetes
  

From prediabetes to family history, each factor increases vulnerability, making early awareness and healthy habits essential for reducing risk.

Prevalence in Certain Populations
Evidence suggests that type 2 and gestational diabetes are more common among (Diabetes Care 2016):

• Indigenous Peoples
• People of African, East Asian, and South Asian backgrounds

This increased prevalence often results from:

• Family history
• Cultural differences and inequities
• Limited opportunities and access to care
  

Genetics, cultural factors, and healthcare access all contribute to these disparities, highlighting the need for targeted prevention and support.

Associated Conditions

The risk of developing type 2 diabetes also increases if you have other conditions, such as:

• Schizophrenia
• Vascular disease
• Polycystic ovary syndrome

Disorders like schizophrenia, vascular disease, and polycystic ovary syndrome add to the overall risk and warrant closer monitoring.

Symptoms of Diabetes

Symptoms of diabetes are caused by elevated blood sugar levels and include:

• Polydipsia-Increased thirst
• Polyuria-Increased thirst
• Unexplained weight loss
• Fatigue
• Blurry vision
• Slow-healing wounds
• Frequent infections

Additional symptoms specific to:

• Men: Erectile dysfunction, decreased muscle strength.
• Women: Vaginal dryness, yeast infections, urinary tract infections.
• Gestational diabetes is often asymptomatic and is typically diagnosed through routine testing during pregnancy.

If these signs sound familiar, the next step is clinical testing for diagnosis.

Diabetes Diagnosis

Diabetes is diagnosed through blood tests, including (ADA Standards of Care in Diabetes — 2023):

• Fasting Blood Glucose Test: Measures blood sugar after fasting for 8 hours (≥126 mg/dL indicates diabetes).
• Oral Glucose Tolerance Test (OGTT): Checks blood sugar levels before and two hours after drinking a glucose solution (≥200 mg/dL confirms diabetes).
• HbA1c Test: Reflects average blood sugar levels over 2-3 months (≥6.5% indicates diabetes).
• Gestational diabetes is diagnosed through glucose challenge and glucose tolerance tests performed during the second trimester.

With diagnosis established, the next priority is understanding and preventing complications.

Diabetes Complications

Poorly managed diabetes can lead to complications such as:

• Cardiovascular Disease: Increased risk of heart attacks and strokes.
• Kidney Damage (Nephropathy): Progressing to chronic kidney disease.
• Nerve Damage (Neuropathy): Pain, tingling, or numbness in extremities.
• Eye Damage (Retinopathy): Potential blindness.
• Foot Complications: Ulcers and infections, sometimes requiring amputation.
• Pregnancy Complications: High birth weight, premature birth, or increased risk of type 2 diabetes in offspring.

With risks identified, evidence-based treatment becomes the priority.

Treatment of Diabetes

Insulin, Medicines, & Other Diabetes Treatments

Taking insulin or other diabetes medicines is often part of treating diabetes. In addition to making healthy food and beverage choices, getting physical activity, getting enough sleep, and managing stress, medicines can help you manage the disease. Some other treatment options are also available.

Read more about Insulin and how to use it here

What Medicines Might I Take for Diabetes?

The medicine you take depends on the type of diabetes you have and how well the medicine controls your blood glucose levels. Other factors, such as your other health conditions, medication costs, and lifestyle, may influence your treatment plan.

What Type of Diabetes Do I Have?

• Type 1 Diabetes: Requires insulin therapy because the pancreas does not produce insulin. Insulin delivery options include syringes, pens, pumps, and artificial pancreas systems.
• Type 2 Diabetes: Managed with lifestyle changes, oral medications, and sometimes insulin. Insulin may be necessary during specific situations like pregnancy or hospital stays.
• Gestational Diabetes: Treated through diet, exercise, and possibly insulin to keep blood glucose levels within a healthy range during pregnancy.
  

Oral Medicines for Type 2 Diabetes

Oral medications, such as metformin, are commonly used to lower blood sugar levels and improve insulin sensitivity. Different drug classes are available, each with its own benefits and possible side effects.

Main Types of Drugs and Their Side Effects:

1. Insulin and analogues (e.g., Regular Insulin)
   Side effects: hypoglycemia, weight gain, insulin allergy, fat loss at injection sites.
   
   
2. Sulphonylureas (e.g., Glibenclamide)
   Side effects: hypoglycemia, weight gain, heart risks, rash, jaundice, bone marrow problems, photosensitivity.
   
   
3. Meglitinides (e.g., Repaglinide)
   Side effects: hypoglycemia, allergic or sensitivity reactions.
   
   
4. Biguanides (e.g., Metformin)
   Side effects: stomach upset, lactic acidosis (rare but serious).
   
   
5. GLP-1 agonists (e.g., Exenatide)
   Side effects: nausea, vomiting, pancreatitis, possible cancer or heart risks.
   
   
6. DPP-4 inhibitors (e.g., Saxagliptin)
   Side effects: pancreatitis, cancer risk, acute hepatitis, kidney problems.
   
   
7. Thiazolidinediones (e.g., Pioglitazone)
   Side effects: liver damage, heart risks, bladder cancer, water retention, weight gain.
   
   
8. Dual PPAR agonists (e.g., Saroglitazar)
   Side effects: gastritis, weakness, fever.
   
   
9. Alpha-glucosidase inhibitors (e.g., Acarbose)
   Side effects: digestive issues, hepatitis.
   
   
10. Amylin analogues (e.g., Pramlintide)
    Side effects: hypoglycemia, allergic reactions.
    
    
11. SGLT-2 inhibitors (e.g., Canagliflozin)
    Side effects: sugar in urine, possible heart concerns.
    
    

Antidiabetic Drugs – British Journal of Pharmaceutical Research 4