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What is diabetes?

Diabetes is long-term metabolic disease that affects around 830 million people wordlwide.¹ It involves high blood sugar due that’s caused by a poor response to the hormone insulin or because not enough insulin is being produced.

If left uncontrolled, high blood sugar levels can damage the blood vessels, heart kidneys, nerves, and the eyes.

Diabetes can be classified as type 1 or type 2, with type 2 the most common.¹

Symptoms of diabetes

Before getting a diagnosis of diabetes, individuals may notice they are: ²

Urinating a lot
Feeling really thirsty
Tired
Experiencing blurry vision
Losing weight
Seeing poor wound healing
Feeling numbness and/or tingling

People may not realise they have diabetes until they become seriously ill with a condition called diabetic ketoacidosis.

Ketoacidosis

Ketoacidosis happens when sugar stays in the blood and can’t enter your cells, causing your body to break down your fat stores for energy instead. By making energy in this way, the body produces a harmful chemical called ketones that causes the blood to become acidic.

Symptoms include those for diabetes, as well as nausea, vomiting, abdominal pain, confusion, and even reduced consciousness.³

Although ketoacidosis usually affects people with type 1 diabetes, it can more rarely affect people with type 2 diabetes.³

Diagnosis of diabetes

Along with experiencing the symptoms above, diagnosis of diabetes is often done via a blood glucose test. A random plasma glucose reading of 11mmol/L or higher suggests diabetes.^4,⁵

Type 1 diabetes

Type 1 is suspected if the individual:⁴

Is younger than 50
Has a BMI of 25kg/m²or less
Has lost weight rapidly
Is in ketoacidosis
Has a personal or family history of autoimmune disease
The symptoms came on suddenly

In some cases (especially if the diagnosis is unclear), extra blood tests are done to check for an autoimmune response or for a genetic cause.

Type 2 diabetes

Type 2 diabetes is suspected if:⁵

Acanthosis nigricans (dark pigmentation of the skin folds) is present – a sign of insulin resistance
Symptoms are more gradual
The individual is older than 50 and/or has risk factors for type 2 diabetes (more on this below)

Usually with type 2 diabetes, the high blood sugar is persistent. This is confirmed by a blood test showing high HbA1c (48 mmol/mol of more) and/or a fasting glucose level of 7.0 mmol/L or more.⁵

Prognosis of diabetes

Diabetes is linked to an increased risk of many different health conditions. Although both type 1 and type 2 diabetes are associated with shorter life expectancies,⁸ treatment is evolving and improving.

Keeping your blood sugar levels within the target range, living at healthy a lifestyle as you can, and attending regular screening can help reduce your risk of developing diabetes-related health conditions.⁴^-⁷

Causes of diabetes

Type 1 diabetes

Type 1 diabetes is caused by the body’s immune system attacking the cells in the pancreas responsible for producing insulin. This is known as an autoimmune response, and results in the body being unable to produce insulin. We don’t fully understand why this happens.¹

Type 1 is more common in children and young people. There may also be a genetic link, but more research is needed into this area.⁴

Type 2 diabetes

Type 2 diabetes can be due to the body becoming resistant to insulin (not responding appropriately), or because it’s not producing enough.¹

This type of diabetes is more common in people: ⁶

That are obese and overweight– this accounts for 80-85% of someone’s risk of developing type 2 diabetes
Who are older
That are Asian, African, and/or Afro-Caribbean
With a family history of diabetes
With a history of gestational diabetes (diabetes when pregnant)
Taking certain drugs (like corticosteroids)
With polycystic ovary syndrome
Who have metabolic syndrome (a combination of high blood pressure, high blood fat levels, fatty liver disease, abdominal obesity, and an increased risk of blood clots)

Treatment of diabetes

Type 1 diabetes

Type 1 diabetes is always treated with insulin as the body is unable to produce enough. Insulin is given through an injection or through an insulin pump (an electronic device that administers insulin).

To know how much insulin to give, patients must monitor their blood sugar by pricking their finger regularly and testing it, or by using a continuous monitoring device that’s stuck into the skin and gives a continuous reading through an app.

Patients often require some education around how to give themselves insulin, how to calculate how much (and the type), what to eat, things to avoid, signs of low blood sugar (hypoglycaemia), and how the diagnosis will affect their life.⁴

Regular follow up is needed to make sugar blood sugar levels are being controlled as well as they can be to avoid complications. It’s important to be screened for eye disease, kidney disease, and thyroid disease regularly, as individuals with type 1 diabetes are at higher risk of developing these problems.⁴

Type 2 diabetes

The treatment for type 2 diabetes is quite individual and depends on how well someone is managing their blood sugar levels. This is based on monitoring HbA1c levels through blood tests. There is no need for individuals with type 2 diabetes to monitor their blood sugar levels themselves in most cases.⁷

Some people can meet their HbA1c target by making diet changes alone and losing weight. Others need medications that help sensitise the body to insulin or to increase insulin production, like metformin. More rarely, some people need to take insulin.

Individuals with type 2 diabetes should also be regularly monitored for eye problems, foot problems, and nerve damage. They should also be checked for signs of cardiovascular disease and kidney disease, as diabetes is a risk factor for these issues.