What is diabetes?
Diabetes is a disease that is diagnosed when there is too much sugar in the blood on a consistent basis. The sugar, also known as glucose, is required by our body’s cells for energy. It is important to understand that insulin (a hormone made by the pancreas) is required for the glucose to be taken into our body’s calls. In diabetes, the glucose is not able to pass into our calls either due to a lack of insulin or because our cells are resistant to the effects of insulin. Having too much glucose in the blood over a long period of time can cause problems with our eyes, our kidneys, our nerves, and our heart.
Why are there two different types of diabetes?
The two main types of diabetes are simply called type 1 diabetes and type 2 diabetes. About 10% of people with diabetes have type 1, and 90% have type 2 diabetes. Type 1 diabetics used to be called juvenile diabetes, because it is usually diagnosed at a younger age than type 2 diabetes. Type 1 diabetes occurs when the pancreas cannot make enough insulin. It is usually occurs fairly quickly and is diagnosed when typical signs of diabetes occur. Type 2 diabetes generally develops over a longer period of time. It used to be called adult-onset diabetes, because it is usually diagnosed later in life.
The road to type 2 diabetes starts with the body’s calls becoming resistant to the effects of insulin. Although many factors increase a person’s risk for developing type 2 diabetes, one especially important risk factor is high body weight, especially when it is around the belly. Blood sugar levels climb slowly until a stage called prediabetes is reached. As blood sugar levels continue to increase, insulin production by the pancreas decreases, and eventually a diagnosis of type 2 diabetes is made. The good news is that type 2 diabetes can be prevented or delayed by improving diet, losing weight, and becoming more physically active.
Who is most likely to get diabetes?
There is not a lot known about what causes type 1 diabetes. Research has shown that risk for type 1 diabetes is slightly increased when a close family member (family, sibling) has it.
There are many factors that have been shown to increase risk for type 2 diabetes. Everyone age 40 years or older should be tested for diabetes every three years. Individuals who have one or more of the following risk factors should be tested more frequently.
- Having a parent, brother, or sister with diabetes
- Being a family member of a high-risk ethnic group (Aboriginal, Hispanic, South Asian, Asian, or African descent)
- Having health complications that are associated with diabetes
- Having given birth to a baby that weighed more than 4 kilograms (9 pounds) at birth or having had diabetes during pregnancy (a form of diabetes known as gestational diabetes)
- Having been diagnosed with prediabetes (impaired glucose tolerance or impaired fasting glucose)
- Having high blood pressure, high cholesterol, or being overweight
- Having been diagnosed with polycystic ovary syndrome
- Having been diagnosed with Acanthosis nigricans (darkened patches of skin)
- Having been diagnosed with psychiatric disorders (schizophrenia, depression, bipolar disorder)
- Having been diagnosed with obstructive sleep apnea
- Having been prescribed a glucocorticoid medication (e.g., prednisone) by a doctor.
What are the signs of diabetes?
Many people who have type 2 diabetes may have no symptoms. However, signs and symptoms of diabetes may include the following:
How is diabetes treated?
All people with diabetes should eat a healthy diet and engage in regular physical activity. A health professional who is a diabetes expert will discuss the diet and physical activity regiments that are best for you.
Type 1 diabetes is always treated with insulin. Type 2 diabetes may also be treated with insulin, especially when an individual has had type 2 diabetes for a long period of time or when it is difficult to control blood glucose with other medications. Insulin is the diabetes drug of choice for women who are pregnant. There are two different types of insulin:
- Basal insulins work over a long period of time and are injected once or twice daily, depending on the particular basal insulin being used.
- Bolus insulins work quickly and are used just before a meal to help control the increases of blood glucose that normally occur after eating.
Type 2 diabetes is most often treated with oral medications, or sometimes with injectable medications called incretin mimetics. However, as mentioned, insulin may also be used, with or without other medications. There are a number of different types of medications used to treat type 2 diabetes:
- Metformin is a tablet that is often the first choice of medicine in the treatment of type 2 diabetes, because it is well tolerated and does not cause low blood sugar or weight gain. It works, in part, by reducing the resistance of the body’s cells to the actions of insulin.
- Sulfonylureas (e.g., gylburide, glimepiride, gliclazide) reduce blood glucose by promoting production of insulin by the pancreas. Because there is more insulin in the system, sulfonylureas increase rick for low blood sugar and weight gain.
- Meglitinides (e.g., nateglinide, repaglinide) also increase the amount of insulin produced by the pancreas but for a shorter period of time than sulfonylureas, so there is a lower risk for low blood sugar or weight gain.
- Dipeptidyl peptidase-4 (DPP-4) inhibitors (e.g., alogliptin, linagliptin, saxagliptin, sitagliptin) prevent the enzyme DPP-4 from breaking down the incretin hormones. Incretin hormones increase insulin and reduce glucose produced by the liver. DPP-4 inhibitors do not cause low blood sugar or weight gain.
- Incretin mimetics (e.g., exenatide, liraglutide) are injectable medications that mimic the action of the incretin hormone glucagon-like peptide-1 (GLP-1). Incretin mimetics increase the amount of insulin in the blood and reduce the amount of glucose produced by the liver. These drugs do not cause low blood sugar or weight gain.
- Sodium-glucose contransporter 2 (SGLT2) inhibitors (e.g., canaglifozin, dapaglifozin) are a new family of antidiabetes medications that work by increasing the amount of blood sugar excreted in the urine. These drugs may cause modest weight loss in some people.
- Thiazolidinediones (TZDs) (e.g., pioglitazone, rosiglitazone) work by reducing the resistance of the body’s cells to the actions of insulin. These drugs do not cause low blood sugar.
- Acarbose is a medication that works by preventing long-chain sugars frm breaking down into glucose molecules after we eat. This prevents the usual high blood glucose levels that normally occur after eating. Acarbose does not promote weight gain, and it is often used in combination with other antidiabetes medications such as metformin.
If your doctor prescribes an antidiabetes medicine for you, it is important to take it exactly as prescribed. Your pharmacist will ensure that you understand the purpose of your medication, the best time to take it, and any side effects or drug interactions that you need to be aware of. If there is anything you do not understand about the directions or if you have and questions about the medicine or about diabetes, your pharmacist will be happy to answer them.