Diabetes is a disease that affects how your body uses glucose (sugar). When you eat foods that contain carbohydrates, like bread, your body breaks down the carbohydrates into glucose, which is absorbed into your bloodstream.
In a healthy person, the beta cells in an organ called the pancreas release a hormone known as insulin. Insulin acts like a key to allow glucose into the cells of your body. Once inside, blood sugar is used as a source of energy. In diabetes, sugar cannot get into the cells causing diabetes symptoms to occur.
Types of Diabetes
The two most common types of diabetes are type 1 diabetes and type 2 diabetes.
About 5-10% of diabetes cases are type 1. In type 1 diabetes, the body’s own immune system attacks the pancreas, destroying the beta cells that normally make insulin. Since the body is unable to make insulin, glucose builds up in the bloodstream. To treat type 1 diabetes, people inject themselves with insulin (1).
A healthy lifestyle is also recommended to manage type 1 diabetes. Type 1 diabetes is often diagnosed in children, although it can be diagnosed in adults too.
Type 2 diabetes accounts for 90-95% of cases of diabetes. In type 2 diabetes insulin is not working properly. This is called “insulin resistance”. Insulin cannot open your cell doors and glucose builds up in the blood stream (1).
Type 2 diabetes is treated with medication, diet, and exercise Type 2 diabetes is typically diagnosed in adults. Unfortunately, due to the unhealthy lifestyles of our modern society, health care professionals are starting to see symptoms of type 2 diabetes in young children.
Prediabetes occurs when someone’s blood sugar is higher than normal, but not high enough to be classified as diabetes. A normal fasting blood sugar is less than 100 mg/dL. If someone has prediabetes, their fasting blood sugar will be between 100-125 mg/dL. A1C, a measure of average blood sugar over 3 months, is normally less than 5.7%. For someone with prediabetes, it will be between 5.7-6.4% (1).
Someone with prediabetes may not have any symptoms of diabetes.
Gestational diabetes is high blood sugar during pregnancy. After the birth of the baby, blood sugar levels return to normal. Women diagnosed with gestational diabetes are at a greater risk for developing type 2 diabetes later in life (1).
What Causes Diabetes?
For people with type 1 diabetes, scientists do not know why the body attacks the pancreas. There are many different studies going on now to try and identify different immune markers and gene variations to help researchers better understand type 1 diabetes.
Type 2 diabetes appears to be caused by a combination of genetics, environment, and lifestyle. The main culprit is insulin resistance (2). Insulin resistance causes your blood sugar to rise, damaging the cells of the pancreas that release insulin. Less insulin is made, contributing to rising blood sugar, further damaging the pancreas. This causes a vicious cycle (3).
Fat, especially saturated fat, contributes to insulin resistance. Saturated fat sticks to insulin receptors, preventing insulin from unlocking the cell doors (4).
Eating foods high in saturated fat like fried foods, bacon, butter, cream, cheese, full-fat dairy, salami, sausage, baloney, and fatty cuts of meat like beef, pork, and poultry with skin, increases insulin resistance. Fortunately, a low-fat diet reverses insulin resistance.
Another risk factor that contributes to insulin resistance in type 2 diabetes is fat around your belly, called abdominal fat. Abdominal fat blocks insulin receptors. Polycystic ovary syndrome (PCOS) is also a risk factor for type 2 diabetes. PCOS causes defects of insulin and insulin receptors (5).
Inactivity increases insulin resistance, but exercise improves insulin sensitivity and lowers blood sugar. Exercise causes your cells to make extra doors appear and open to let sugar in, lowering blood sugar (6). One exercise session can lower your blood sugar for up to 24 hours (6)!
If you can exercise for 1 week, insulin sensitivity begins to improve (6).
7 Early Symptoms of Diabetes
Symptoms of type 1 diabetes and type 2 diabetes can be similar, but symptoms of type 1 diabetes can occur rather suddenly. If you are having symptoms of diabetes, call your doctor to get tested for diabetes. The most common diabetes symptoms include increased thirst, urination, and fatigue.
1. Increased Thirst
Being unable to quench your thirst can be a symptom of diabetes. All that extra sugar in your blood causes fluid to move out of your cells and into your bloodstream (7).
Since your cells are “thirsty”, they send a message to your brain to drink more.
2. Increased Urination
This symptom goes hand in hand with increased thirst. Not only does all the extra fluid that moved out of your cells into the bloodstream contribute to having to pee all the time, but the extra fluids you are drinking must also go somewhere (7).
Sweet-smelling pee can also be a symptom of diabetes. Sugar in your bloodstream is entering your urine.
Normally, sugar acts as a source of energy for your cells. In diabetes, the sugar is unable to get inside your cells and be used as energy. Since your cells are unable to use this energy source, you feel tired and fatigued (7).
4. Unexplained Weight Loss
On the surface, weight loss may seem like a good thing. But when you lose weight because of diabetes, you are losing muscle tissue as well as fat (7).
Your cells can’t use the sugar in your bloodstream, so they break down your muscular tissue for energy.
5. Blurry Vision
High blood sugar causes water to be pulled into the lens of the eye, resulting in swelling (7).
Even after you get your blood sugar under control, it can take 6 weeks or longer for the swelling to go down and vision to return to normal (8).
6. Sores That Do Not Heal
When your blood sugar is high, it coats your immune system with a sticky layer of sugar, making it difficult for it to work properly. Additionally, bacteria feed off the extra sugar in your blood, helping them thrive. The combination of these two things keeps sores from healing (7, 9).
7. Burning, Numbness or Tingling in Feet or Hands
High blood sugar damages your nerves, preventing them from working properly. This can cause a sensation of burning, numbness, or tingling in your feet and/or hands (7).
People with type 1 diabetes who have uncontrolled blood glucose are at risk for diabetic ketoacidosis. Unlike the other diabetes symptoms listed, diabetic ketoacidosis is a serious complication of diabetes. The combination of low insulin and elevated glucose causes fat to be quickly converted into ketones.
Ketones build up in the bloodstream and become toxic. Symptoms of diabetic ketoacidosis can be like diabetes symptoms, but you may have a fruity-smelling breath as well. If you check your blood sugar and it is above 240 mg/dL and/or you check your urine and it has ketones in it, call your doctor right away! Diabetic ketoacidosis is a life-threatening medical emergency (12).
There is no way to prevent type 1 diabetes. It is a condition that can be managed through frequent blood sugar checks and insulin administration.
On the other hand, people at risk for type 2 diabetes can delay or even prevent the onset of diabetes with healthy lifestyle changes. The Diabetes Prevention Program showed that with positive changes, people lowered the risk of developing type 2 diabetes by 58% over 3 years (10).
The 2 major goals of The Diabetes Prevention Program are losing 7% of one’s body weight and 150 minutes of exercise each week. This means that if someone is 250 pounds, they would want to lose 18 pounds over 6 months and exercise at least 30 minutes 5 days a week. You can ask your doctor for a referral to the Diabetes Prevention Program.
If you are new to exercise, choose an exercise that you enjoy and can see yourself doing long term. Brisk walking, swimming, dancing, weight training, and cycling are all ideas. You can find many free exercise classes on the internet or even with your cable package. Many gyms offer a week of free classes, so you can “shop” around to find something that you enjoy.
While exercise is important for health, your nutrition is key to weight loss. To lose weight, you must create a calorie deficit. The Mediterranean Diet and the Dietary Approaches to Stop Hypertension are recommended by the American Diabetes Association to help you lose weight and improve your nutrition.
Eat lots of vegetables, fruits, whole grains, beans, nuts, lean protein, and low-fat dairy while avoiding saturated fats, processed meats, and sweets. By making healthy changes, you may be able to stop type 2 diabetes and avoid any diabetes symptoms!
How Does Diabetes Make You Feel?
People with diabetes may be affected both physically and emotionally. I worked as a registered dietitian and certified diabetes educator (now certified diabetes care and education specialist) for 4 years helping individuals manage their diabetes. Some people did not “feel” anything with their diabetes.
They told me they felt fine and saw no reason to make any lifestyle changes. Others felt tired all the time and were relieved to find out why. Some patients had been getting sick a lot and had cuts that weren’t healing. Others had been extremely thirsty.
One patient, who had been trying to lose weight, was disappointed when she found out she had diabetes. She felt that she had only been losing weight because of her diabetes and not her hard work.
Some patients felt ashamed or guilty about their diabetes diagnosis. Others sobbed in my office, terrified they were going to lose their feet or go blind. Some were determined to control their diabetes, motivated to make changes, and lower their risk of long term complications. Anything you feel is valid.
Can You Have Diabetes Without Knowing?
You can absolutely have diabetes without knowing, especially type 2. Blood sugar levels often creep up over time so it can be higher than normal but not high enough for symptoms. Therefore your doctor should test for diabetes on everyone over age 45. If someone is a high risk, they may be tested earlier.
Risk factors for type 2 diabetes include obesity, family history, history of gestational diabetes, ethnicity such as African American, Asian American, Hispanic, and Pacific Islander.
- American Diabetes Association. “Classification and Diagnosis of Diabetes,” Diabetes Care, January 2020, https://care.diabetesjournals.org/content/43/Supplement_1/S14.
- R. J. Mahler and M. L. Adler. “Type 2 Diabetes Mellitus: Update on Diagnosis, Pathophysiology, and Treatment,” The Journal of Clinical Endocrinology & Metabolism, 1 April 1999, https://academic.oup.com/jcem/article/84/4/1165/2864079#53746186.
- The Ohio State University., “DIABETES MELLITUS TYPE 2,” The Ohio State University College of Nursing, https://u.osu.edu/diabetestype2/diagnosis/.
- National Institute of Diabetes Digestive and Kidney Diseases. “Symptoms & Causes of Diabetes,” National Institute of Diabetes Digestive and Kidney Diseases, December 2016, https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes#type
- K. Permanente and A. Waring. “Eye damage with diabetes,” Kaiser Permanente, 3 January 2019. https://wa.kaiserpermanente.org/healthAndWellness/index.jhtml?item=%2Fcommon%2FhealthAndWellness%2Fconditions%2Fdiabetes%2Feyes.html.
- A. C. Weintrob and D. J. Sexton. “Susceptibility to infections in persons with diabetes mellitus,” UpToDate, 11 July 2018, https://www uptodate-com.chnlib.idm.oclc.org/contents/susceptibility-to-infections-in-persons-with-diabetes-mellitus search=diabetes%20immune%20system&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
- American Diabetes Association. “Prevention or Delay of Type 2 Diabetes,” Diabetes Care, January 2020, https://care.diabetesjournals.org/content/43/Supplement_1/S32.
- Centers for Disease Control, “Diabetes Basics,” Centers for Disease Control, 2019 30 May, https://www.cdc.gov/diabetes/basics/index.html.
- G. Michael, “What Causes Insulin Resistance?,” NutritionFacts.org, 6 January 2017, https://nutritionfacts.org/video/what-causes-insulin-resistance/.
- J. C. Marshall and A. Dunaif, “All Women With PCOS Should Be Treated For Insulin Resistance,” HHS Manuscript, January 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277302/
- D. K. McCulloch, “Effects of exercise in adults with diabetes mellitus,” 20 September 2029, https://www-uptodate-com.chnlib.idm.oclc.org/contents/effects-of-exercise-in-adults-with-diabetes-mellitus?search=exercise%20and%20diabetes&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H7.
- JDRF. “Diabetic Ketoacidosis (DKA): Symptoms and Prevention,” JDRJ, https://www.jdrf.org/t1d-resources/about/symptoms/ketoacidosis/