Diabetes mellitus type 2 (also known as type 2 diabetes) is a long term metabolic disorder that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, and unexplained weight loss. Symptoms may also include increased hunger, feeling tired, and sores that do not heal.
Often symptoms come on slowly. Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations. The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.
Type 2 diabetes primarily occurs as a result of obesity and not enough exercise. Some people are more genetically at risk than others. Type 2 diabetes makes up about 90% of cases of diabetes, with the other 10% due primarily to diabetes mellitus type 1 and gestational diabetes. In diabetes mellitus type 1 there is an absolute lack of insulin due to breakdown of islet cells in the pancreas. Diagnosis of
diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or A1C.
Type 2 diabetes is partly preventable by staying a normal weight, exercising regularly, and eating properly. Treatment involves exercise and dietary changes. If blood sugar levels are not adequately lowered, the medication metformin is typically recommended. Many people may eventually also require insulin injections. In those on insulin, routinely checking blood sugar levels is advised; however, this may not be needed in those taking pills. Bariatric surgery often improves diabetes in those who are obese.
Rates of type 2 diabetes have increased markedly since 1960 in parallel with obesity. As of 2013 there were approximately 368 million people diagnosed with the disease compared to around 30 million in 1985. Typically it begins in middle or older age, although rates of type 2 diabetes are increasing in young people. Type 2 diabetes is associated with a ten-year-shorter life expectancy. Diabetes was one of the first diseases described. The importance of insulin in the disease was determined in the 1920s.
Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following:
Fasting plasma glucose level at or above 7.0 mmol/L (126 mg/dL).
Plasma glucose at or above 11.1 mmol/L (200 mg/dL) two hours after a 75 g oral glucose load as in a glucose tolerance test.
Symptoms of hyperglycemia and casual plasma glucose at or above 11.1 mmol/L (200 mg/dL).
Glycated hemoglobin (hemoglobin A1C) at or above 48 mmol/mol (≥ 6.5 DCCT %). (This criterion was recommended by the American Diabetes Association in 2010, although it has yet to be adopted by the WHO.)
About a quarter of people with new type 1 diabetes have developed some degree of diabetic ketoacidosis (a type of metabolic acidosis which is caused by high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids) by the time the diabetes is recognized. The diagnosis of other types of diabetes is usually made in other ways.
These include ordinary health screening, detection of hyperglycemia during other medical investigations, and secondary symptoms such as vision changes or unexplained fatigue. Diabetes is often detected when a person suffers a problem that may be caused by diabetes, such as a heart attack, stroke, neuropathy, poor wound healing or a foot ulcer, certain eye problems, certain fungal infections, or delivering a baby with macrosomia or hypoglycemia (low blood sugar).
A positive result, in the absence of unequivocal hyperglycemia, should be confirmed by a repeat of
any of the above-listed methods on a different day. Most physicians prefer to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test. According to the current definition, two fasting glucose measurements above 126 mg/dL (7.0 mmol/L) is considered diagnostic for diabetes mellitus.
In type 1, pancreatic beta cells in the islets of Langerhans are destroyed, decreasing endogenous insulin production. This distinguishes type 1's origin from type 2. Type 2 diabetes is characterized by insulin resistance, while type 1 diabetes is characterized by insulin deficiency, generally without insulin resistance. Another hallmark of type 1 diabetes is islet autoreactivity, which is generally measured by the presence of autoantibodies directed towards the beta cells.
Autoantibodies
The appearance of diabetes-related autoantibodies has been shown to be able to predict the appearance of diabetes type 1 before any hyperglycemia arises, the main ones being islet cell autoantibodies, insulin autoantibodies, autoantibodies targeting the 65-kDa isoform of glutamic acid decarboxylase (GAD), autoantibodies targeting the phosphatase-related IA-2 molecule, and zinc transporter autoantibodies (ZnT8).
By definition, the diagnosis of diabetes type 1 can be made first at the appearance of clinical symptoms and/or signs, but the emergence of autoantibodies may itself be termed "latent autoimmune diabetes". Not everyone with autoantibodies progresses to diabetes type 1, but the risk increases with the number of antibody types, with three to four antibody types giving a risk of progressing to diabetes type 1 of 60% to 100%.
The time interval from emergence of autoantibodies to clinically diagnosable diabetes can be a few months in infants and young children, but in some people it may take years – in some cases more than 10 years. Islet cell autoantibodies are detected by conventional immunofluorescence, while the rest are measured with specific radiobinding assays.
Diabetes mellitus type 1 (also known as type 1 diabetes) is a form of diabetes mellitus in which not enough insulin is produced. The lack of insulin results in high blood sugar levels. The classical symptoms are frequent urination, increased thirst, increased hunger, and weight loss. Additional symptoms may include blurry vision, feeling tired, and poor healing. Symptoms typically develop over a short period of time.
The cause of type 1 diabetes is unknown. However, it is believed to involve a combination of genetic and environmental factors. Risk factors include having a family member with the condition. The underlying mechanism involves an autoimmune destruction of the insulin-producing beta cells in the pancreas. Diabetes is diagnosed by testing the level of sugar or A1C in the blood. Type 1 diabetes may be distinguished from type 2 by autoantibody testing.
There is no known way to prevent type 1 diabetes. Treatment with insulin is typically required for survival. Insulin therapy is usually given by injection just under the skin but can also be delivered by an insulin pump. A diabetic diet and exercise are an important part of management. Untreated, diabetes can cause many complications.
Complications of relatively rapid onset include diabetic ketoacidosis and nonketotic hyperosmolar coma. Long-term complications include heart disease, stroke, kidney failure, foot ulcers and damage to the eyes. Furthermore, complications may arise from low blood sugar caused by excessive insulin treatment.
Type 1 diabetes makes up an estimated 5–10% of all diabetes cases. The number of people affected globally is unknown, although it is estimated that about 80,000 children develop the disease each ear. Within the United States the number of people affected is estimated at one to three million. ates of disease vary widely with approximately 1 new case per 100,000 per year in East Asia and Latin America and around 30 new cases per 100,000 per year in Scandinavia and Kuwait. It typically begins in children and young adults.
Modulating and ameliorating diabetic complications may in turn improve the overall quality of life for diabetic patients. For example; when elevated blood pressure was tightly controlled, diabetic related deaths were reduced by 32% compared to those with less controlled blood pressure. Many observational and clinical studies had been conducted to investigate the role of several vitamins on
diabetic complications, the results of these studies elevated a suggested beneficial role of vitamins on diabetic complications.
In the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study, vitamin supplementations were observed to be associated with 24% reduction on the risk of diabetes was observed during 20 years of follow-up. Many observational studies and clinical trials have linked several vitamins with the pathological process of diabetes; these vitamin include
folate, thiamine, β-carotene, and vitamin E, C, B 12, and D.
However, numerous researches had been shown inconsistent results about the roles of vitamins on diabetic risk and complications. Most of these researches performed to investigate effect of individual vitamin without looking to status of other vitamins. Even though, it is expected that vitamin supplementation might be more effective and might induce a beneficial role on diabetic process when
deficiency exists.
Despite the current contradictory in the association between the discussed vitamins and diabetic complications, and regardless of the lack of strong and inclusive evidence about their mechanism of action, the discussed effects of these vitamins seem promising for preventing and reducing the severity of diabetic complications.
Since optimal blood level of all vitamins is important for normal metabolic process, it is essential to encourage diabetic patients and high risk population to try to achieve and maintain this level. And until more inclusive evidence is established about vitamins supplementations, the awareness of diabetic patients should be elevated toward the importance of consuming adequate amounts of all vitamins.
Thiamine: Thiamine acts as an essential cofactor in glucose metabolism, therefore, it may modulate diabetic complications by controlling glycemic status in diabetic patients. Additionally, deficiency of thiamine was observed to be associated with dysfunction of β-cells and impaired glucose tolerance. Different studies indicated possible role of thiamin supplementation on the prevention or reversal of early stage diabetic nephropathy, as well as significant improvement on lipid profile.
vitamin B12: Low serum B12 level is common finding in diabetic patients especially those taking Metformin or advanced age patients. Vitamin B12 deficiency has been linked to two diabetic complications; atherosclerosis and diabetic neuropathy.
Folic acid: Low plasma concentrations of folic acid were found to be associated with high plasma homocysteine concentrations. In clinical trials, homocysteine concentrations were effectively reduced within 4 to 6 weeks of oral supplementation of folic acid. Moreover, since the activity of endothelial NO synthase enzyme might be potentially elevated by folate, folate supplementation might be capable of restoring the availability of NO in endothelium, therefore, improving endothelial function and reducing the risk for atherosclerosis. van Etten et al., found that a single dose of folic acid might help in reducing the risk of vascular complications and enhancing endothelial function in adults with type 2 diabetes by improving nitric oxide status.
Antioxidants: Three vitamins, ascorbic acid; α-tocopherol; and β-carotene, are well recognized for their antioxidant activities in human. Free radical-scavenging ability of antioxidants may reduce the oxidative stress and thus may protect against oxidative damage. Based on observational studies among healthy individuals, antioxidant concentrations were found to be inversely correlated with several biomarkers of insulin resistance or glucose intolerance.
Antioxidants may induce beneficial effects on diabetic complications by reducing blood pressure, attenuating oxidative stress and inflammatory biomarkers, improving lipid metabolism and insulin-mediated glucose disposal, as well as by enhancing endothelial function. In addition to its antioxidant capacity, vitamin C has been proposed to induce beneficial effects on diabetes by two other mechanisms.
Firstly; vitamin C may replace the glucose in many chemical reactions due to their similarity in structure, thus, it may prevent the non-enzymatic glycosylation of proteins, and therefore it might reduce glycated hemoglobin (HbA1c) levels. Secondly, vitamin C has also been suggested to play an important role in lipid regulation as a controller of catabolism of cholesterol to bile acid.
Vitamin D: The insufficiency of vitamin D is a common finding in diabetic patients. Observational studies showed that serum vitamin D is inversely associated with biomarkers of diabetes; impaired insulin secretion, insulin resistance, and glucose intolerance. It has been suggested that vitamin D may induce a beneficial effects on diabetic complications by several mechanisms. Firstly; it could modulate differentiation and growth of pancreatic β-cells and it may also protect these cells from apoptosis, thus improving β-cells functions and survival.
Vitamin D has also been suggested to act on immune system and modulate inflammatory responses by influencing proliferation and differentiation of different immune cells. Moreover, deficiency of vitamin D may contribute to diabetic complications by inducing hyperparathyroidism, since elevated parathyroid hormone levels are associated with reduced β-cells function, impaired insulin sensitivity, and glucose intolerance. Finally, vitamin D may reduce the risk of vascular complications by modulating lipid profile
Chronic elevation of blood glucose level leads to damage of blood vessels (angiopathy). The endothelial cells lining the blood vessels take in more glucose than normal, since they do not depend on insulin. They then form more surface glycoproteins than normal, and cause the basement membrane to grow thicker and weaker.
In diabetes, the resulting problems are grouped under "microvascular disease" (due to damage to small blood vessels) and "macrovascular disease" (due to damage to the arteries).However, some research challenges the theory of hyperglycemia as the cause of diabetic complications. The fact that 40% of diabetics who carefully control their blood sugar nevertheless develop neuropathy, requires explanation.
It has been discovered that the serum of diabetics with neuropathy is toxic to nerves even if its blood sugar content is normal. Recent research suggests that in type 1 diabetics, the continuing autoimmune disease which initially destroyed the beta cells of the pancreas may also cause retinopathy, neuropathy, and nephropathy.
One researcher has even suggested that retinopathy may be better treated by drugs to suppress the abnormal immune system of diabetics than by blood sugar control.
The familial clustering of the degree and type of diabetic complications indicates that genetics may also play a role in causing complications such as diabetic retinopathy and nephropathy. Non-diabetic offspring of type 2 diabetics have been found to have increased arterial stiffness and neuropathy despite normal blood glucose levels, and elevated enzyme levels associated with diabetic renal disease have been found in non-diabetic first-degree relatives of diabetics.However, one study continued for 41 months found that the initial worsening of complications from improved glucose control was not followed by the expected improvement in the complications.
In a systematic review with meta-analysis including 6 randomized controlled trials involving 27,654 patients, tight blood glucose control reduces the risk for some macrovascular and microvascular events, without effect on all-cause mortality and cardiovascular mortality. In terms of pathophysiology, studies show that the two main types of DM (DM1 and DM2) cause a change in balancing of metabolites such as carbohydrates, lipids and blood coagulation factors, and subsequently bring about complications like microvascular and cardiovascular complications
Examples of chronic complications
The damage to small blood vessels leads to a microangiopathy, which can cause one or more of the following:
Diabetic cardiomyopathy, damage to the heart muscle, leading to impaired relaxation and filling of the heart with blood (diastolic dysfunction) and eventually heart failure; this condition can occur independent of damage done to the blood vessels over time from high levels of blood glucose.
Diabetic nephropathy, damage to the kidney which can lead to chronic renal failure, eventually requiring dialysis.
Diabetes mellitus is the most common cause of adult kidney failure in the developed world.
Diabetic neuropathy, abnormal and decreased sensation, usually in a 'glove and stocking' distribution starting with the feet but potentially in other nerves, later often fingers and hands. When combined with damaged blood vessels this can lead to diabetic foot (see below). Other forms of diabetic neuropathy may present as mononeuritis or autonomic neuropathy. Diabetic amyotrophy is muscle weakness due to neuropathy.
Diabetic retinopathy, growth of friable and poor-quality new blood vessels in the retina as well as macular edema (swelling of the macula), which can lead to severe vision loss or blindness. Retinal damage (from microangiopathy) makes it the most common cause of blindness among non-elderly adults in the US.
Diabetic encephalopathy is the increased cognitive decline and risk of dementia, including (but not limited to) the Alzheimer's type, observed in diabetes. Various mechanisms are proposed, including alterations to the vascular supply of the brain and the interaction of insulin with the brain itself.
Macrovascular disease leads to cardiovascular disease, to which accelerated atherosclerosis is a contributor:
Coronary artery disease, leading to angina or myocardial infarction ("heart attack")
Diabetic myonecrosis ('muscle wasting')
Peripheral vascular disease, which contributes to intermittent claudication (exertion-related leg and foot pain) as well as diabetic foot.
Stroke (mainly the ischemic type)
Diabetic foot, often due to a combination of sensory neuropathy (numbness or insensitivity) and vascular damage, increases rates of skin ulcers (diabetic foot ulcers) and infection and, in serious cases, necrosis and gangrene. It is why diabetics are prone to leg and foot infections and why it takes longer for them to heal from leg and foot wounds. It is the most common cause of non-traumatic adult amputation, usually of toes and or feet, in the developed world.
Carotid artery stenosis does not occur more often in diabetes, and there appears to be a lower prevalence of abdominal aortic aneurysm. However, diabetes does cause higher morbidity, mortality and operative risks with these conditions. In the developed world, diabetes is the most significant cause of adult blindness in the non-elderly and the leading cause of non-traumatic amputation in adults, and diabetic nephropathy is the main illness requiring renal dialysis in the United States. A review of type 1 diabetes came to the result that, despite modern treatment, women with diabetes are at increased risk of female infertility, such as reflected by delayed puberty and menarche, menstrual
irregularities (especially oligomenorrhoea), mild hyperandrogenism, polycystic ovarian syndrome, fewer live born children and possibly earlier menopause.
Animal models indicate that abnormalities on the molecular level caused by diabetes include defective leptin, insulin and kisspeptin signalling. Restrictive lung defect is known to be associated with diabetes. Lung restriction in diabetes could result from chronic low-grade tissue inflammation, microangiopathy, and/or accumulation of advanced glycation end products. In fact the presence restrictive lung defect in association with diabetes has been shown even in presence of obstructive lung diseases like asthma and copd in diabetic patients.
Lipohypertrophy may be caused by insulin therapy. Repeated insulin injections at the same site, or near to, causes an accumulation of extra subcutaneous fat and may present as a large lump under the skin. It may be unsightly, mildly painful, and may change the timing or completeness of insulin action.
Researchers have found an association of depression and diabetes in a 2010 study. A longitudinal study of 4,263 individuals diagnosed with type 2 diabetes were followed from 2005-2007 and were found to have a statistically significant association with depression and a high risk of micro and macro-vascular events.
The complications of diabetes mellitus are far less common and less severe in people who have well-controlled blood sugar levels. Conversely, some genes appear to provide protection against diabetic
complications, as evidenced by the absence of complications in a subset of long-term diabetes survivors.
Wider health problems accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise
Acute
Diabetic ketoacidosis
Diabetic ketoacidosis (DKA) is an acute and dangerous complication that is always a medical emergency and requires prompt medical attention. Low insulin levels cause the liver to turn fatty acid to ketone for fuel (i.e., ketosis); ketone bodies are intermediate substrates in that metabolic sequence. This is normal when periodic, but can become a serious problem if sustained.
Elevated levels of ketone bodies in the blood decrease the blood's pH, leading to DKA. On presentation at hospital, the patient in DKA is typically dehydrated, and breathing rapidly and deeply. Abdominal pain is common and may be severe. The level of consciousness is typically normal until
late in the process, when lethargy may progress to coma. Ketoacidosis can easily become severe enough to caus hypotension, shock, and death.
Urine analysis will reveal significant levels of ketone bodies (which have exceeded their renal threshold blood levels to appear in the urine, often before other overt symptoms). Prompt, proper treatment usually results in full recovery, though death can result from inadequate or delayed treatment, or from complications (e.g., brain edema). Ketoacidosis is much more common in type 1 diabetes than type 2.
Hyperglycemia hyperosmolar state
Hyperosmolar nonketotic state (HNS) is an acute complication sharing many symptoms with DKA, but an entirely different origin and different treatment. A person with very high (usually considered to be above 300 mg/dl (16 mmol/L)) blood glucose levels, water is osmotically drawn out of cells into the blood and the kidneys eventually begin to dump glucose into the urine. This results in loss of water and an increase in blood osmolarity.
If fluid is not replaced (by mouth or intravenously), the osmotic effect of high glucose levels, combined with the loss of water, will eventually lead to dehydration. The body's cells become progressively dehydrated as water is taken from them and excreted. Electrolyte imbalances are also common and are always dangerous. As with DKA, urgent medical treatment is necessary, commonly beginning with fluid volume replacement. Lethargy may ultimately progress to a coma, though this is more common in type 2 diabetes than type 1
Hypoglycemia
Hypoglycemia, or abnormally low blood glucose, is an acute complication of several diabetes treatments. It is rare otherwise, either in diabetic or non-diabetic patients. The patient may become agitated, sweaty, weak, and have many symptoms of sympathetic activation of the autonomic nervous
system resulting in feelings akin to dread and immobilized panic.
Consciousness can be altered or even lost in extreme cases, leading to coma, seizures, or even brain damage and death. In patients with diabetes, this may be caused by several factors, such as too much or incorrectly timed insulin, too much or incorrectly timed exercise (exercise decreases insulin requirements) or not enough food (specifically glucose containing carbohydrates). The variety of interactions makes cause identification difficult in many instances.
It is more accurate to note that iatrogenic hypoglycemia is typically the result of the interplay of absolute (or relative) insulin excess and compromised glucose counterregulation in type 1 and advanced type 2 diabetes. Decrements in insulin, increments in glucagon, and, absent the latter, increments in epinephrine are the primary glucose counterregulatory factors that normally prevent or (more or less rapidly) correct hypoglycemia. In insulin-deficient diabetes (exogenous) insulin levels
do not decrease as glucose levels fall, and the combination of deficient glucagon and epinephrine responses causes defective glucose counterregulation.Furthermore, reduced sympathoadrenal responses can cause hypoglycemia unawareness. The concept of hypoglycemia-associated autonomic
failure (HAAF) in diabetes posits that recent incidents of hypoglycemia causes both defective glucose counterregulation and hypoglycemia unawareness.
By shifting glycemic thresholds for the sympathoadrenal (including epinephrine) and the resulting neurogenic responses to lower plasma glucose concentrations, antecedent hypoglycemia leads to a vicious cycle of recurrent hypoglycemia and further impairment of glucose counterregulation. In many cases (but not all), short-term avoidance of hypoglycemia reverses hypoglycemia unawareness in affected patients, although this is easier in theory than in clinical experience.
In most cases, hypoglycemia is treated with sugary drinks or food. In severe cases, an injection of glucagon (a hormone with effects largely opposite to those of insulin) or an intravenous infusion of dextrose is used for treatment, but usually only if the person is unconscious. In any given incident, glucagon will only work once as it uses stored liver glycogen as a glucose source; in the absence of such stores, glucagon is largely ineffective. In hospitals, intravenous dextrose is often used.
Diabetic coma
Diabetic coma is a medical emergency in which a person with diabetes mellitus is comatose (unconscious) because of one of the acute complications of diabetes:
Severe diabetic hypoglycemia
Diabetic ketoacidosis advanced enough
to result in unconsciousness from a combination of severe hyperglycemia,
dehydration and shock, and exhaustion
Hyperosmolar nonketotic coma in which
extreme hyperglycemia and dehydration alone are sufficient to cause
unconsciousness.
In most medical contexts, the term diabetic coma refers to the diagnostical dilemma posed when a physician is confronted with an unconscious patient about whom nothing is known except that he has diabetes. An example might be a physician working in an emergency department who receives an
unconscious patient wearing a medical identification tag saying DIABETIC. Paramedics may be called to rescue an unconscious person by friends who identify him as diabetic. Brief descriptions of the three major conditions are followed by a discussion of the diagnostic process used to distinguish among them, as well as a few other conditions which must be considered.An estimated 2 to 15 percent of diabetics will suffer from at least one episode of diabetic coma in their lifetimes as a result of severe hypoglycemia.
Erectile Dysfunction
Estimates of the prevalence of erectile dysfunction in men with diabetes range from 20 to 85 percent. Erectile dysfunction is a consistent inability to have an erection firm enough for sexual intercourse.
Among men with erectile dysfunction, those with diabetes are likely to have experienced the problem as much as 10 to 15 years earlier than men withoutdiabetes.
Respiratory infections
The immune response is impaired in individuals with diabetes mellitus. Cellular studies have shown that hyperglycemia both reduces the function of immune cells and increases inflammation. The vascular effects of diabetes also tend to alter lung function, all of which leads to an increase in susceptibility to respiratory infections such as pneumonia and influenza among individuals with diabetes. Several studies also show diabetes associated with a worse disease course and slower recovery from respiratory infections.
Periodontal disease
Diabetes is associated with periodontal disease (gum disease) which may make diabetes more difficult to treat. Gum disease is frequently related to bacterial infection by organisms such as Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans. A number of trials have found improved blood sugar levels in type 2 diabetics who have undergone peridontal treatment
As of 2016, 422 million people have diabetes worldwide, up from an estimated 382 million people in 2013 and from 108 million in 1980. Accounting for the shifting age structure of the global population, the prevalence of diabetes is 8.5% among adults, nearly double the rate of 4.7% in 1980. Type 2 makes up about 90% of the cases. Some data indicate rates are roughly equal in women and
men, but male excess in diabetes has been found in many populations with higher type 2 incidence, possibly due to sex-related differences in insulin sensitivity, consequences of obesity and regional body fat deposition, and other contributing factors such as high blood pressure, tobacco smoking, and
alcohol intake.
The World Health Organization (WHO) estimates that diabetes mellitus resulted in 1.5 million deaths in 2012, making it the 8th leading cause of death. However another 2.2 million deaths worldwide were attributable to high blood glucose and the increased risks of cardiovascular disease and other associated complications (e.g. kidney failure), which often lead to premature death and are often listed as the underlying cause on death certificates rather than diabetes. For example, in 2014, the International Diabetes Federation (IDF) estimated that diabetes resulted in 4.9 million deaths worldwide, using modeling to estimate the total amount of deaths that could be directly or indirectly
attributed to diabetes.
Diabetes mellitus occurs throughout the world but is more common (especially type 2) in more developed countries. The greatest increase in rates has however been seen in low- and middle-income countries, where more than 80% of diabetic deaths occur. The fastest prevalence increase is expected to occur in Asia and Africa, where most people with diabetes will probably live in 2030. The increase in rates in developing countries follows the trend of urbanization and lifestyle changes, including increasingly sedentary lifestyles, less physically demanding work and the global nutrition transition, marked by increased intake of foods that are high energy-dense but nutrient-poor (often high in sugar and saturated fats, sometimes referred to as the "Western-style" diet).
Diabetes mellitus is a chronic disease, for which there is no known cure except in very specific situations. Management concentrates on keeping blood sugar levels as close to normal, without causing low blood sugar. This can usually be accomplished with a healthy diet, exercise, weight loss, and use of appropriate medications (insulin in the case of type 1 diabetes; oral medications, as well as possibly insulin, in type 2 diabetes).
Learning about the disease and actively participating in the treatment is important, since complications are far less common and less severe in people who have well-managed blood sugar levels.The goal of treatment is an HbA1C level of 6.5%, but should not be lower than that, and may be set higher. Attention is also paid to other health problems that may accelerate the negative effects of diabetes.
These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise. Specialized footwear is widely used to reduce the risk of ulceration, or re-ulceration, in at-risk diabetic feet. Evidence for the efficacy of this remains equivocal, however.
Diabetic diet
People with diabetes can benefit from education about the disease and treatment, good nutrition to achieve a normal body weight, and exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure
Anti-diabetic medication
Medications used to treat diabetes do so by lowering blood sugar levels. There are a number of different classes of anti-diabetic medications. Some are available by mouth, such as metformin, while others are only available by injection such as GLP-1 agonists. Type 1 diabetes can only be treated with insulin, typically with a combination of regular and NPH insulin, or synthetic insulin analogs.
Metformin is generally recommended as a first line treatment for type 2 diabetes, as there is good evidence that it decreases mortality. It works by decreasing the liver's production of glucose. Several other groups of drugs, mostly given by mouth, may also decrease blood sugar in type II DM. These include agents that increase insulin release, agents that decrease absorption of sugar from the intestines, and agents that make the body more sensitive to insulin. When insulin is used in type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications. Doses of insulin are then increased to effect.
Since cardiovascular disease is a serious complication associated with diabetes, some have recommended blood pressure levels below 130/80 mmHg. However, evidence supports less than or equal to somewhere between 140/90 mmHg to 160/100 mmHg; the only additional benefit found for blood pressure targets beneath this range was an isolated decrease in stroke risk, and this was accompanied by an increased risk of other serious adverse events. A 2016 review found potential
harm to treating lower than 140 mmHg. Among medications that lower blood pressure, angiotensin converting enzyme inhibitors (ACEIs) improve outcomes in those with DM while the similar medications angiotensin receptor blockers (ARBs) do not. Aspirin is also recommended for people with cardiovascular problems, however routine use of aspirin has not been found to improve outcomes in uncomplicated diabetes.
Surgery
A pancreas transplant is occasionally considered for people with type 1 diabetes who have severe complications of their disease, including end stage kidney disease requiring kidney transplantation.
Weight loss surgery in those with obesity and type two diabetes is often an effective measure. Many
are able to maintain normal blood sugar levels with little or no medications following surgery and long-term mortality is decreased. There however is some short-term mortality risk of less than 1% from the surgery.The body mass index cutoffs for when surgery is appropriate are not yet clear. It is recommended that this option be considered in those who are unable to get both their weight and blood sugar under control.
Support
In countries using a general practitioner system, such as the United Kingdom, care may take place
mainly outside hospitals, with hospital-based specialist care used only in case of complications, difficult blood sugar control, or research projects. In other circumstances, general practitioners and specialists share care in a team approach. Home telehealth support can be an effective management technique.
A positive result, in the absence of unequivocal high blood sugar, should be confirmed by a repeat of any of the above methods on a different day. It is preferable to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test. According to the current definition, two fasting glucose measurements above 126 mg/dl (7.0 mmol/l) is considered diagnostic for diabetes mellitus.
Per the World Health Organization people with fasting glucose levels from 6.1 to 6.9 mmol/l (110 to 125 mg/dl) are considered to have impaired fasting glucose. People with plasma glucose at or above 7.8 mmol/l (140 mg/dl), but not over 11.1 mmol/l (200 mg/dl), two hours after a 75 g oral glucose load are considered to have impaired glucose tolerance. Of these two prediabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus, as well as cardiovascular disease.
The American Diabetes Association since 2003 uses a slightly different range for impaired fasting glucose of 5.6 to 6.9 mmol/l (100 to 125 mg/dl). Glycated hemoglobin is better than fasting glucose for determining risks of cardiovascular disease and death from any cause.
Prevention
There is no known preventive measure for type 1 diabetes. Type 2 diabetes — which accounts for 85-90% of all cases — can often be prevented or delayed by maintaining a normal body weight, engaging in physical exercise, and consuming a healthful diet. Higher levels of physical activity (more than 90 minutes per day) reduce the risk of diabetes by 28%. Dietary changes known to be effective in helping to prevent diabetes include maintaining a diet rich in whole grains and fiber, and choosing good fats, such as the polyunsaturated fats found in nuts, vegetable oils, and fish. Limiting
sugary beverages and eating less red meat and other sources of saturated fat can also help prevent diabetes. Tobacco smoking is also associated with an increased risk of diabetes and its complications, so smoking cessation can be an important preventive measure as well.
The relationship between type 2 diabetes and the main modifiable risk factors (excess weight, unhealthy diet, physical inactivity and tobacco use) is similar in all regions of the world. There is growing evidence that the underlying determinants of diabetes are a reflection of the major forces driving social, economic and cultural change: globalization, urbanization, population aging, and the general health policy environment.
Insulin is the principal hormone that regulates the uptake of glucose from the blood into most cells of the body, especially liver, adipose tissue and muscle, except smooth muscle, in which insulin acts via the IGF-1. Therefore, deficiency of insulin or the insensitivity of its receptors plays a central role in all forms of diabetes mellitus.
The body obtains glucose from three main places: the intestinal absorption of food; the breakdown of glycogen, the storage form of glucose found in the liver; and gluconeogenesis, the generation of glucose from non-carbohydrate substrates in the body. Insulin plays a critical role in balancing glucose levels in the body. Insulin can inhibit the breakdown of glycogen or the process of gluconeogenesis, it can stimulate the transport of glucose into fat and muscle cells, and it can stimulate the storage of glucose in the form of glycogen.
Insulin is released into the blood by beta cells (β-cells), found in the islets of Langerhans in the pancreas, in response to rising levels of blood glucose, typically after eating. Insulin is used by about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, for conversion to other needed molecules, or for storage. Lower glucose levels result in decreased insulin release from the beta cells and in the breakdown of glycogen to glucose. This process is mainly controlled by the hormone glucagon, which acts in the opposite manner to insulin.
If the amount of insulin available is insufficient, if cells respond poorly to the effects of insulin (insulin insensitivity or insulin resistance), or if the insulin itself is defective, then glucose will not be absorbed properly by the body cells that require it, and it will not be stored appropriately in the liver and muscles. The net effect is persistently high levels of blood glucose, poor protein synthesis, and other metabolic derangements, such as acidosis.
When the glucose concentration in the blood remains high over time, the kidneys will reach a threshold of reabsorption, and glucose will be excreted in the urine (glycosuria). This increases the osmotic pressure of the urine and inhibits reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Lost blood volume will be replaced osmotically from water held in body cells and other body compartments, causing dehydration and increased thirst
(polydipsia).
Prediabetes indicates a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 DM. Many people destined to develop type 2 DM spend many years in a state of prediabetes.
Latent autoimmune diabetes of adults (LADA) is a condition in which type 1 DM develops in adults.
Adults with LADA are frequently initially misdiagnosed as having type 2 DM, based on age rather than etiology. Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization when the current taxonomy was introduced in 1999.
Other forms of diabetes mellitus include congenital diabetes, which is due to genetic defects of insulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms of monogenic diabetes.
"Type 3 diabetes" has been suggested as a term for Alzheimer's disease as the underlying processes may involve insulin resistance by the brain.
The following is a comprehensive list of other causes of diabetes:
Genetic defects of β-cell function
Maturity onset diabetes of the young
Mitochondrial
DNA mutations
Genetic defects in insulin processing or insulin action
Type 2 DM is characterized by insulin resistance, which may be combined with relatively reduced insulin secretion. The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor. However, the specific defects are not known. Diabetes mellitus cases due to a known defect are classified separately. Type 2 DM is the most common type of diabetes mellitus.
In the early stage of type 2, the predominant abnormality is reduced insulin sensitivity. At this stage, high blood sugar can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce the liver's glucose production. Type 2 DM is due primarily to lifestyle factors and genetics. A number of lifestyle factors are known to be important to the development of type 2 DM, including obesity (defined by a body mass index of greater than 30), lack of physical activity, poor diet, stress, and urbanization. Excess body fat is associated with 30% of cases in those of Chinese and Japanese descent, 60–80% of cases in those of European and African descent, and 100% of Pima Indians and Pacific Islanders. Even those who are not obese often have a high waist–hip ratio.
Dietary factors also influence the risk of developing type 2 DM. Consumption of sugar-sweetened drinks in excess is associated with an increased risk. The type of fats in the diet is also important, with saturated fats and trans fatty acids increasing the risk and polyunsaturated and monounsaturated fat decreasing the risk. Eating lots of white rice also may increase the risk of diabetes. A lack of exercise is believed to cause 7% of cases.
Gestational diabetes Gestational diabetes mellitus (GDM) resembles type 2 DM in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2–10% of all pregnancies and may improve or disappear after delivery. However, after pregnancy approximately 5–10% of women with gestational diabetes are found to have diabetes mellitus, most commonly type 2. Gestational diabetes is fully treatable, but requires careful medical supervision throughout the pregnancy. Management may include dietary changes, blood glucose monitoring, and in some cases, insulin may be required.
Though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital heart and central nervous system abnormalities, and skeletal muscle malformations. Increased levels of insulin in a fetus's blood may inhibit fetal surfactant production and cause respiratory distress syndrome. A high blood bilirubin level may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Labor induction may be indicated with decreased placental function. A Caesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.
Diabetes mellitus is classified
into four broad categories: type 1, type 2, gestational diabetes, and
"other specific types". The "other specific types" are a
collection of a few dozen individual causes.
Diabetes is a more variable
disease than once thought and people may have combinations of forms. The term
"diabetes", without qualification, usually refers to diabetes
mellitus.
Causes of Diabetes mellitus Type 1
Type 1 diabetes mellitus is
characterized by loss of the insulin-producing beta cells of the islets of
Langerhans in the pancreas, leading to insulin deficiency. This type can be
further classified as immune-mediated or idiopathic.
The majority of type 1 diabetes
is of the immune-mediated nature, in which a T-cell-mediated autoimmune attack
leads to the loss of beta cells and thus insulin. It causes approximately 10%
of diabetes mellitus cases in North America and Europe.
Most affected people are
otherwise healthy and of a healthy weight when onset occurs. Sensitivity and
responsiveness to insulin are usually normal, especially in the early stages.
Type 1 diabetes can affect children or adults, but was traditionally termed
"juvenile diabetes" because a majority of these diabetes cases were
in children.
"Brittle" diabetes,
also known as unstable diabetes or labile diabetes, is a term that was
traditionally used to describe the dramatic and recurrent swings in glucose
levels, often occurring for no apparent reason in insulin-dependent diabetes.
This term, however, has no biologic basis and should not be used.
Still, type 1 diabetes can be accompanied by
irregular and unpredictable high blood sugar levels, frequently with ketosis,
and sometimes with serious low blood sugar levels. Other complications include
an impaired counterregulatory response to low blood sugar, infection,
gastroparesis (which leads to erratic absorption of dietary carbohydrates), and
endocrinopathies (e.g., Addison's disease). These phenomena are believed to
occur no more frequently than in 1% to 2% of persons with type 1 diabetes.
Type 1 diabetes is partly
inherited, with multiple genes, including certain HLA genotypes, known to
influence the risk of diabetes. The increase of incidence of type 1 diabetes
reflects the modern lifestyle. In genetically susceptible people, the onset of
diabetes can be triggered by one or more environmental factors, such as a viral
infection or diet.
Several viruses have been
implicated, but to date there is no stringent evidence to support this
hypothesis in humans. Among dietary factors, data suggest that gliadin (a
protein present in gluten) may play a role in the development of type 1
diabetes, but the mechanism is not fully understood.
The classic symptoms of untreated diabetes are weight loss, polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Symptoms may develop rapidly (weeks or months) in type 1 DM, while they usually develop much more slowly and may be subtle or absent in type 2 DM.
Several other signs and symptoms can mark the onset of diabetes although they are not specific to the disease. In addition to the known ones above, they include blurry vision, headache, fatigue, slow healing of cuts, and itchy skin. Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting in vision changes. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes.
Several other signs and symptoms can mark the onset of diabetes although they are not specific to the disease. In addition to the known ones above, they include blurry vision, headache, fatigue, slow healing of cuts, and itchy skin. Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting in vision changes. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes.
Diabetic emergencies
Low blood sugar is common in persons with type 1 and type 2 DM. Most cases are mild and are not considered medical emergencies. Effects can range from feelings of unease, sweating, trembling, and increased appetite in mild cases to more serious issues such as confusion, changes in behavior such as aggressiveness, seizures, unconsciousness, and (rarely) permanent brain damage or death in severe cases. Moderate hypoglycemia may easily be mistaken for drunkenness; rapid breathing and sweating, cold, pale skin are characteristic of hypoglycemia but not definitive. Mild to moderate cases are self-treated by eating or drinking something high in sugar. Severe cases can lead to unconsciousness and must be treated with intravenous glucose or injections with glucagon.
People (usually with type 1 DM) may also experience episodes of diabetic ketoacidosis, a metabolic disturbance characterized by nausea, vomiting and abdominal pain, the smell of acetone on the breath, deep breathing known as Kussmaul breathing, and in severe cases a decreased level of consciousness.
A rare but equally severe possibility is hyperosmolar nonketotic state, which is more common in type 2 DM and is mainly the result of dehydration
Complications
All forms of diabetes increase the risk of long-term complications. These typically develop after many years (10–20) but may be the first symptom in those who have otherwise not received a diagnosis before that time.
The major long-term complications relate to damage to blood vessels. Diabetes doubles the risk of cardiovascular disease and about 75% of deaths in diabetics are due to coronary artery disease.Other "macrovascular" diseases are stroke, and peripheral vascular disease.
The primary complications of diabetes due to damage in small blood vessels include damage to the eyes, kidneys, and nerves. Damage to the eyes, known as diabetic retinopathy, is caused by damage to the blood vessels in the retina of the eye, and can result in gradual vision loss and blindness. Damage to the kidneys, known as diabetic nephropathy, can lead to tissue scarring, urine protein loss, and eventually chronic kidney disease, sometimes requiring dialysis or kidney transplant. Damage to the nerves of the body, known as diabetic neuropathy, is the most common complication of diabetes. The symptoms can include numbness, tingling, pain, and altered pain sensation, which can lead to damage to the skin. Diabetes-related foot problems (such as diabetic foot ulcers) may occur, and can be difficult to treat, occasionally requiring amputation. Additionally, proximal diabetic neuropathy causes painful muscle wasting and weakness.
The classic symptoms of untreated diabetes are weight loss, polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Symptoms may develop rapidly (weeks or months) in type 1 DM, while they usually develop much more slowly and may be subtle or absent in type 2 DM.
Several other signs and symptoms can mark the onset of diabetes although they are not specific to the disease. In addition to the known ones above, they include blurry vision, headache, fatigue, slow healing of cuts, and itchy skin. Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting in vision changes. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes.
Several other signs and symptoms can mark the onset of diabetes although they are not specific to the disease. In addition to the known ones above, they include blurry vision, headache, fatigue, slow healing of cuts, and itchy skin. Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting in vision changes. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes.
Diabetic emergencies
Low blood sugar is common in persons with type 1 and type 2 DM. Most cases are mild and are not considered medical emergencies. Effects can range from feelings of unease, sweating, trembling, and increased appetite in mild cases to more serious issues such as confusion, changes in behavior such as aggressiveness, seizures, unconsciousness, and (rarely) permanent brain damage or death in severe cases. Moderate hypoglycemia may easily be mistaken for drunkenness; rapid breathing and sweating, cold, pale skin are characteristic of hypoglycemia but not definitive. Mild to moderate cases are self-treated by eating or drinking something high in sugar. Severe cases can lead to unconsciousness and must be treated with intravenous glucose or injections with glucagon.
People (usually with type 1 DM) may also experience episodes of diabetic ketoacidosis, a metabolic disturbance characterized by nausea, vomiting and abdominal pain, the smell of acetone on the breath, deep breathing known as Kussmaul breathing, and in severe cases a decreased level of consciousness.
A rare but equally severe possibility is hyperosmolar nonketotic state, which is more common in type 2 DM and is mainly the result of dehydration
Complications
All forms of diabetes increase the risk of long-term complications. These typically develop after many years (10–20) but may be the first symptom in those who have otherwise not received a diagnosis before that time.
The major long-term complications relate to damage to blood vessels. Diabetes doubles the risk of cardiovascular disease and about 75% of deaths in diabetics are due to coronary artery disease.Other "macrovascular" diseases are stroke, and peripheral vascular disease.
The primary complications of diabetes due to damage in small blood vessels include damage to the eyes, kidneys, and nerves. Damage to the eyes, known as diabetic retinopathy, is caused by damage to the blood vessels in the retina of the eye, and can result in gradual vision loss and blindness. Damage to the kidneys, known as diabetic nephropathy, can lead to tissue scarring, urine protein loss, and eventually chronic kidney disease, sometimes requiring dialysis or kidney transplant. Damage to the nerves of the body, known as diabetic neuropathy, is the most common complication of diabetes. The symptoms can include numbness, tingling, pain, and altered pain sensation, which can lead to damage to the skin. Diabetes-related foot problems (such as diabetic foot ulcers) may occur, and can be difficult to treat, occasionally requiring amputation. Additionally, proximal diabetic neuropathy causes painful muscle wasting and weakness.
The classic symptoms of untreated diabetes are weight loss, polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Symptoms may develop rapidly (weeks or months) in type 1 DM, while they usually develop much more slowly and may be subtle or absent in type 2 DM.
Several other signs and symptoms can mark the onset of diabetes although they are not specific to the disease. In addition to the known ones above, they include blurry vision, headache, fatigue, slow healing of cuts, and itchy skin. Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting in vision changes. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes.
Several other signs and symptoms can mark the onset of diabetes although they are not specific to the disease. In addition to the known ones above, they include blurry vision, headache, fatigue, slow healing of cuts, and itchy skin. Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting in vision changes. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes.
Diabetic emergencies
Low blood sugar is common in persons with type 1 and type 2 DM. Most cases are mild and are not considered medical emergencies. Effects can range from feelings of unease, sweating, trembling, and increased appetite in mild cases to more serious issues such as confusion, changes in behavior such as aggressiveness, seizures, unconsciousness, and (rarely) permanent brain damage or death in severe cases. Moderate hypoglycemia may easily be mistaken for drunkenness; rapid breathing and sweating, cold, pale skin are characteristic of hypoglycemia but not definitive. Mild to moderate cases are self-treated by eating or drinking something high in sugar. Severe cases can lead to unconsciousness and must be treated with intravenous glucose or injections with glucagon.
People (usually with type 1 DM) may also experience episodes of diabetic ketoacidosis, a metabolic disturbance characterized by nausea, vomiting and abdominal pain, the smell of acetone on the breath, deep breathing known as Kussmaul breathing, and in severe cases a decreased level of consciousness.
A rare but equally severe possibility is hyperosmolar nonketotic state, which is more common in type 2 DM and is mainly the result of dehydration
Complications
All forms of diabetes increase the risk of long-term complications. These typically develop after many years (10–20) but may be the first symptom in those who have otherwise not received a diagnosis before that time.
The major long-term complications relate to damage to blood vessels. Diabetes doubles the risk of cardiovascular disease and about 75% of deaths in diabetics are due to coronary artery disease.Other "macrovascular" diseases are stroke, and peripheral vascular disease.
The primary complications of diabetes due to damage in small blood vessels include damage to the eyes, kidneys, and nerves. Damage to the eyes, known as diabetic retinopathy, is caused by damage to the blood vessels in the retina of the eye, and can result in gradual vision loss and blindness. Damage to the kidneys, known as diabetic nephropathy, can lead to tissue scarring, urine protein loss, and eventually chronic kidney disease, sometimes requiring dialysis or kidney transplant. Damage to the nerves of the body, known as diabetic neuropathy, is the most common complication of diabetes. The symptoms can include numbness, tingling, pain, and altered pain sensation, which can lead to damage to the skin. Diabetes-related foot problems (such as diabetic foot ulcers) may occur, and can be difficult to treat, occasionally requiring amputation. Additionally, proximal diabetic neuropathy causes painful muscle wasting and weakness.
Levels Naturally High blood sugar occurs when your body can’t effectively transport sugar from blood into cells.
When left unchecked, this can lead to diabetes. One study from 2012 reported that 12–14% of US adults had type 2 diabetes, while 37–38% were classified as pre-diabetic
This means that 50% of all US adults have diabetes or pre-diabetes.
Here are 15 easy ways to lower blood sugar levels naturally:
1. Exercise regularly
Regular exercise can help you lose weight and increase insulin sensitivity.
Increased insulin sensitivity means your cells are better able to use the available sugar in your
bloodstream.
Exercise also helps your muscles use blood sugar for energy and muscle contraction.
If you have problems with blood sugar control, you should routinely check your levels. This will help you learn how you respond to different activities and keep your blood sugar levels from getting either too high or too low
Good forms of exercise include weight lifting, brisk walking, running, biking, dancing, hiking, swimming and more.
Exercise increases insulin sensitivity and helps your muscles pick up sugars from the blood. This can lead to reduced blood sugar levels
2. Control your carb intake
Your body breaks carbs down into sugars (mostly glucose), and then insulin moves the sugars into cells.
When you eat too many carbs or have problems with insulin function, this process fails and blood glucose levels rise.
However, there are several things you can do about this. The American Diabetes Association (ADA) recommends controlling carb intake by counting carbs or using a food exchange system
Some studies find that these methods can also help you plan your meals appropriately, which may further improve blood sugar control
Many studies also show that a low-carb diet helps reduce blood sugar levels and prevent blood sugar spikes
What’s more, a low-carb diet can help control blood sugar levels in the long run Carbs are broken down into glucose, which raises blood sugar levels. Reducing carbohydrate intake can help with blood sugar control.
3. Increase your fiber intake
Fiber slows carb digestion and sugar absorption. For these reasons, it promotes a more gradual rise in blood sugar levels. Furthermore, the type of fiber you eat may play a role.
There are two kinds of fiber: insoluble and soluble. While both are important, soluble fiber specifically has been shown to lower blood sugar levels Additionally, a high-fiber diet can help manage type 1 diabetes by improving blood sugar control and reducing blood sugar lows Foods that are high in fiber include vegetables, fruits, legumes and whole grains.
The recommended daily intake of fiber is about 25 grams for women and 38 grams for men. That’s about 14 grams for every 1,000 calories
Eating plenty of fiber can help with blood sugar control, and soluble dietary fiber is the most effective.
4. Drink water and stay hydrated
Drinking enough water may help you keep your blood sugar levels within healthy limits.
In addition to preventing dehydration, it helps your kidneys flush out the excess blood sugar through
urine. One observational study showed that those who drank more water had a lower risk of developing high blood sugar levels
Drinking water regularly re-hydrates the blood, lowers blood sugar levels and reduces diabetes risk
Keep in mind that water and other non-caloric beverages are best. Sugar-sweetened drinks raise blood glucose, drive weight gain and increase diabetes risk
Staying hydrated can reduce blood sugar levels and help prevent diabetes. Water is best.
5. Implement portion control
Portion control helps regulate calorie intake and can lead to weight loss Consequently, controlling your weight promotes healthy blood sugar levels and has been shown to reduce the risk of developing type 2 diabetes
Monitoring your serving sizes also helps reduce calorie intake and subsequent blood sugar spikes Here are some helpful tips for controlling portions:
• Measure and weigh portions.
• Use smaller plates.
• Avoid all-you-can-eat restaurants.
• Read food labels and check the serving sizes.
• Keep a food journal.
• Eat slowly.
The more control you have over your serving sizes the better control you will have over your blood sugar levels.
6. Choose foods with a low glycemic index
The glycemic index was developed to assess the body’s blood sugar response to foods that contain carbs
Both the amount and type of carbs determine how a food affects blood sugar levels
Eating low-glycemic-index foods has been shown to reduce long-term blood sugar levels in type 1 and type 2 diabetics
Although the glycemic index of foods is important, the amount of carbs consumed also matters
Foods with a low glycemic index include seafood, meat, eggs, oats, barley, beans, lentils, legumes, sweet potatoes, corn, yams, most fruits and non-starchy vegetables.
It’s important to choose foods with a low glycemic index and watch your overall carb intake.
7. Control stress levels
Stress can affect your blood sugar levels
Hormones such as glucagon and cortisol are secreted during stress. These hormones cause blood sugar levels to go up
One study showed that exercise, relaxation and meditation significantly reduced stress and lowered blood sugar levels for students
Exercises and relaxation methods like yoga and mindfulness-based stress reduction can also correct insulin secretion problems in chronic diabetes
Controlling stress levels through exercise or relaxation methods such as yoga will help you control blood sugars.
8. Monitor your blood sugar levels
Measuring and monitoring blood glucose levels can also help you control them. For example, keeping track helps you determine whether you need to make adjustments in meals or medications
It will also help you find out how your body reacts to certain foods
Try measuring your levels every day, and keeping track of the numbers in a log.
Checking your sugars and maintaining a log every day will help you adjust foods and medications to
decrease your sugar levels.
9. Get enough quality sleep
Getting enough sleep feels great and is necessary for good health
Poor sleeping habits and a lack of rest also affect blood sugar levels and insulin sensitivity. They can
increase appetite and promote weight gain
Sleep deprivation decreases the release of growth hormones and increases cortisol levels. Both of these play an important role in blood sugar control
Furthermore, good sleep is about both quantity and quality. It is best to get a sufficient amount of high-quality sleep every night
Good sleep helps maintain blood sugar control and promote a healthy weight. Poor sleep can disrupt important metabolic hormones.
10. Eat foods rich in chromium and magnesium
High blood sugar levels and diabetes have also been linked to micronutrient deficiencies Examples include deficiencies in the minerals chromium and magnesium.
Chromium is involved in carb and fat metabolism. It also helps control blood sugar levels, and a lack of chromium may predispose you to carb intolerance
However, the mechanisms behind this are not completely known. Studies also report mixed findings.
Two studies of diabetes patients showed that chromium had benefits for long-term blood sugar control. However, another study showed no benefits
Chromium-rich foods include egg yolks, whole-grain products, high-bran cereals, coffee, nuts, green beans, broccoli and meat.
Magnesium has also been shown to affect blood sugar levels, and magnesium deficiency has been linked to a higher risk of developing diabetes
In one study, people with the highest magnesium intake had a 47% lower risk of becoming diabetic
However, if you already eat plenty of magnesium-rich foods, then you probably will not benefit from
supplements
Magnesium-rich foods include dark leafy greens, whole grains, fish, dark chocolate, bananas, avocados and beans.
Eating foods rich in chromium and magnesium on a regular basis can help prevent deficiencies and reduce blood sugar problems.
11. Try apple cider vinegar
Apple cider vinegar has many benefits for your health.
It promotes lower fasting blood sugar levels, possibly by decreasing its production by the liver or increasing its use by cells
What’s more, studies show that vinegar significantly influences your body’s response to sugars and improves insulin sensitivity
To incorporate apple cider vinegar into your diet, you can add it to salad dressings or mix 2 teaspoons in 8 ounces of water.
However, it’s important to check with your doctor before taking apple cider vinegar if you are already taking medications that lower blood sugar.
Adding apple cider vinegar to your diet can help your body in many ways, including reducing blood sugar levels.
12. Experiment with cinnamon extract
Cinnamon is known to have many health benefits.
For one, it has been shown to improve insulin sensitivity by decreasing insulin resistance at the cellular level
Studies show cinnamon can also lower blood sugar levels by up to 29%
It slows the breakdown of carbs in the digestive tract, which moderates the rise in blood sugar after a meal
Cinnamon also acts in a similar way as insulin, although at a much slower rate
An effective dose is 1–6 grams of cinnamon per day, or about 0.5–2 teaspoons
However, definitely don’t take more than that since too much cinnamon can be harmful.
Cinnamon has been shown to reduce fasting blood sugar levels and improve insulin sensitivity.
13. Try berberine
Berberine is the active component of a Chinese herb that’s been used to treat diabetes for thousands of years.
Berberine has been shown to help lower blood sugar and enhance the breakdown of carbs for energy
What’s more, berberine may be as effective as some blood sugar lowering drugs. This makes it one of the most effective supplements for those with diabetes or pre-diabetes
However, many of the mechanisms behind its effects are still unknown
Additionally, it may have some side effects. Diarrhea, constipation, flatulence and abdominal pain have been reported
A common dosage protocol is 1,500 mg per day, taken before meals as 3 doses of 500 mg.
Berberine works well for lowering blood sugar levels and can help manage diabetes. However, it may have some digestive side effects.
14. Eat fenugreek seeds
Fenugreek seeds are a great source of soluble fiber, which can help control blood sugar levels.
Many studies have shown that fenugreek can effectively lower blood sugar in diabetics. It also helps reduce fasting glucose and improve glucose tolerance
Although not that popular, fenugreek can easily be added to baked goods to help treat diabetes. You can also make fenugreek flour or brew it into tea
Fenugreek seeds are also considered one of the safest herbs for diabetes The recommended dose of fenugreek seeds is 2–5 grams per day.
Consider giving fenugreek seeds a try. They are easy to add to your diet and can help regulate blood glucose levels.
15. Lose some weight
It’s a no-brainer that maintaining a healthy weight will improve your health and prevent future health problems.
Weight control also promotes healthy blood sugar levels and has been shown to reduce your risk of developing diabetes
Even a 7% reduction in body weight can decrease your risk of developing diabetes by up to 58%, and it seems to work even better than medication
What’s more, these decreased risks can be sustained over the years
You should also be conscious of your waistline, as it is perhaps the most important weight-related factor for estimating your diabetes risk.
A measurement of 35 inches (88.9 cm) or more for women and 40 inches (101.6 cm) or more for men is associated with an increased risk of developing insulin resistance, high blood sugar levels and type 2 diabetes
Having a healthy waist measurement may be even more important than your overall weight
