Diabetes mellitus, or diabetes, is a disease that is, unfortunately, becoming more well-known.
The incidence of diabetes is increasing; according to the World Health Organization (WHO), the number of people with diabetes has risen from 108 million people in 1980 to 422 million in 2014.
Diabetes is a disease affecting the pancreas and its ability to produce the hormone insulin. When the insulin-producing cells of the pancreas are destroyed, or when the body doesn’t respond to insulin as well as it should, blood sugar (blood glucose) levels rise, and diabetes can develop.
Insulin helps blood glucose (blood sugar) enter our cells, used as fuel to support all of the body’s functions. Without enough insulin, sugar remains in the bloodstream and can become dangerously high. Having high blood sugar over a prolonged period of time is detrimental to health.
Unfortunately, many people with diabetes may not even know they have it. In fact, of the 34.2 million adults with diabetes in 2018, 26.8 million were diagnosed, and 7.3 million were undiagnosed. Going along with undiagnosed diabetes can increase the risk of diabetes complications.
Knowing the diabetes symptoms can help provide an earlier diagnosis, which can preserve both health and quality of life.
Having chronic high blood sugar without treatment can increase the likelihood of diabetes-related health complications, which is why it’s crucial to get a diagnosis and begin treatment if diabetes is suspected.
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The dangers of undiagnosed diabetes
Blood sugar is commonly measured in terms of milligrams per deciliter (mg/dL). A blood glucose level above 200 mg/dL at any time is considered very high. High blood sugar levels can be dangerous.
In type 1 diabetes, very high blood sugar can lead to a life-threatening condition called diabetic ketoacidosis (DKA).
DKA occurs when insulin levels are deficient, which causes the body to start producing ketones to use as fuel instead of glucose. A sign of ketone bodies being present is fruity-smelling breath.DKA can be fatal, so prompt medical attention is required.
Some symptoms of DKA include:
In type 2 diabetes, very high blood sugar can cause hyperglycemic hyperosmolar syndrome (HHS). HHS doesn’t cause ketones to build up, but it does present as:
- Very high blood sugar
- Decreased alertness
Over time, high blood sugar does damage to the arteries and vessels of the body. When these vessels are damaged, complications can occur. Some of the complications from chronic high blood sugar include:
- Heart (cardiovascular) disease: people with diabetes are two to four times more likely to die from cardiovascular disease than those without diabetes. People with diabetes are also more likely to have high blood pressure, which is another risk factor for heart disease. A heart attack is one potential complication of heart disease.
- Stroke: Diabetes increases the risk of stroke, as well as increases mortality when a stroke occurs.
- Kidney disease and failure: High blood sugar damages the kidneys and can lead to kidney disease. About one in four people with diabetes have kidney disease.
- Poor wound healing leading to amputations: High blood sugar inhibits proper wound healing. Diabetes is thought to be the leading cause of leg amputations worldwide.
- Neuropathy: Damage to the nerves, which can cause painful symptoms like numb and tingling legs and feet and delayed stomach emptying from damage to the nerves of the stomach.
- Retinopathy and blindness: Damage to the nerves in the eyes is called retinopathy, leading to blindness if not treated.
Symptoms of undiagnosed diabetes
There are many symptoms of diabetes; some of them are physical, and some are diagnosed with blood tests. Typically, people with undiagnosed diabetes present with physical symptoms, which brings them into their healthcare provider for an exam.
Excessive urination (polyuria): Elevated blood glucose levels cause an imbalance of dissolved particles in the urine. When there is a lot of sugar in the urine, the body attempts to dilute the sugar by pulling fluid from the body. The result is increased urine volume due to less water being absorbed by the kidney and more being excreted through the bladder. People usually notice polyuria when they wake up several times per night to urinate, especially without increasing their fluid intake.
Excessive thirst (polydipsia): Excessive thirst is connected to increased urination. When someone is losing more fluids due to increased urination, it can be dehydrating. Dehydration stimulates thirst, which then contributes to the increased urination from increased urine volume. Because the thirst is due to high blood sugar levels and dehydration, drinking more water may not quench thirst as it does in people without undiagnosed diabetes. These two symptoms have a cyclic effect and feed off of each other, worsening both symptoms.
Unintentional weight loss: Cells require sugar (glucose) for energy; glucose is the preferred energy source over other sources. Cells have insulin receptors, which insulin attaches to in order to let the sugar in. An easier way to think of it is that the cells have doors, the insulin receptors are the doorknobs, and insulin is the key to open the doorknob to allow sugar in to feed the cells. Without enough insulin to provide glucose to feed the cells, the body starts burning fat and muscle for energy instead, which leads to unintentional weight loss.
Increased hunger: When cells are starved of glucose for energy (due to lack of insulin or insulin resistance), it can increase the sensation of hunger to try to compensate and gain enough calories to use for fuel. People with undiagnosed diabetes may notice that they are hungrier than usual and still losing weight due to uncontrolled blood sugar levels.
What can raise your risk?
There are three main types of diabetes: type 1, type 2, and gestational diabetes.
Type 1 diabetes
Type 1 diabetes is an autoimmune disease and isn’t as prevalent as type 2. Diabetes type 1 affects about 2-5% of the world’s population and about 1 in 300 American adults before the age of 18. Type 1 usually occurs before age 18, which is why it’s also referred to as juvenile diabetes.
The risk factors for type 1 diabetes aren’t as well-understood as the other types of diabetes because it’s very different from the other types. Risk factors for developing type 1 diabetes include:
- Family history: people with a parent or sibling with type 1 diabetes are more likely to develop it than people without a family history.
- Genetics: certain genes tend to indicate an increased risk of type 1 diabetes.
- Geography: incidence of type 1 diabetes tends to increase as the distance from the equator increases.
- Age: the first peak of diagnosis tends to occur between ages 4-7, and again between ages 10-14.
Type 2 diabetes
Type 2 diabetes is more common and isn’t an autoimmune disease. It can occur in adolescence but is more common in older adults.
Type 2 diabetes occurs when the pancreas stops producing enough insulin, or the body doesn’t respond to insulin the way it should. When the body doesn’t use insulin effectively, it’s called insulin resistance.
Things that can increase your risk of developing type 2 diabetes include:
- Having prediabetes. This condition occurs when blood sugar levels are elevated, but not enough to be diagnosed as diabetes. Prediabetes is diagnosed when fasting blood sugars are between 100-125 mg/dL and/or a hemoglobin A1c (longer-term blood sugar test) is 5.7-6.4%.
- Weight: people who are considered overweight or obese according to their body mass index (BMI).
- Age: people 45 and older are at increased risk.
- Family history of diabetes
- Race/ethnicity: diabetes tends to affect certain races more than others. At-risk races include African American, Alaska Native, Native American, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander.
- High blood pressure: if your blood pressure is higher than 120/80, you may be at increased risk.
- Altered lipid levels: low levels of HDL “good” cholesterol and high levels of LDL “bad” cholesterol are risk factors, as well as high triglycerides (blood fat).
- Pregnancy history: women with a history of gestational diabetes (GDM) or gave birth to a baby 9 pounds or heavier are at increased risk.
- Physical activity: people who aren’t regularly active or who have a sedentary lifestyle are at increased risk.
- Smoking status: Smokers are 30-40% more likely to develop type 2 diabetes than nonsmokers.
- Health history: those with a history of heart attack or stroke have a higher likelihood of developing type 2 diabetes.
- PCOS: Polycystic Ovarian Syndrome in women is a risk factor, as it usually is associated with insulin resistance.
- Acanthosis nigricans: dark, velvety patches of skin are a sign of insulin resistance and are a risk factor for developing diabetes. These patches of skin usually occur around the neck or armpits.
Gestational diabetes (GDM) occurs during pregnancy and can affect women without a previous history of diabetes. The drastic shift in hormones during pregnancy can trigger insulin resistance, resulting in higher blood sugars. It typically goes away after pregnancy but can increase the risk of type 2 diabetes later in life.
Risk factors for developing GDM include:
- Being at a higher weight when becoming pregnant.
- Being African-American, Asian, Hispanic, or Native American
- Having a history of prediabetes or GDM
- Having high blood pressure or other medical problems
- Having given birth to a large baby weighing 9 pounds or more
- Having given birth to a stillborn baby or one with congenital disabilities
- Being over the age of 25
Type 1 diabetes is an autoimmune condition, so it doesn’t have known prevention steps. In order to prevent type 2 diabetes and gestational diabetes:
- Aim for a healthy weight. Being at a higher weight (“overweight” or “obese” according to body mass index [BMI]) is associated with an increased risk of type 2 diabetes. Studies have found that a 5% reduction in body weight in those considered overweight or obese significantly reduced their risk of developing type 2 diabetes. In pregnancy, having a healthy rate of weight gain may help reduce the risk of gestational diabetes.
- Be physically active. Being physically active is a very important way to reduce the risk of type 2 diabetes. 150 minutes per week of moderate physical activity, such as brisk walking, is associated with a reduction in diabetes risk.
- Get screened. Regular diabetes screenings can help catch high blood sugar before it turns into diabetes. A fasting blood sugar test and/or a hemoglobin A1c test are usually the preferred ways to screen for blood sugar problems.
- Cut back on sugar. While eating sugar doesn’t cause diabetes, a higher intake of sugar has been associated with an increased risk of diabetes, along with many other factors. Added sugars tend to be especially detrimental to health since they don’t provide any nutritional value and cause large blood sugar fluctuations. The American Heart Association recommends that women consume no more than 6 teaspoons of added sugar per day (24 grams) and men consume no more than 9 teaspoons of added sugar per day (36 grams).
- Eat more fiber. A high-fiber diet has been associated with a decreased risk of type 2 diabetes. Fiber is also beneficial for promoting heart health and can help reduce the risk of cardiovascular disease. A good amount of fiber to aim for is around 30 grams per day.
Diabetes is a chronic health condition that is associated with certain complications such as the increased risk of heart attack, stroke, and amputations. It presents three main types: type 1, type 2, and gestational diabetes. Type 2 diabetes is the most prevalent type today.
Diabetes is increasing in prevalence, and many people have undiagnosed diabetes and do not even know it. Knowing the risk factors associated with diabetes, as well as the symptoms, can help achieve an earlier diagnosis that can improve quality of life and reduce the risk of complications.
A few lifestyle habits which can help reduce the risk of certain types of diabetes (mainly type 2) include being at a healthy weight, being physically active, and eating a healthy diet.
Some people may still get diabetes despite leading a healthy lifestyle, which is why having regular blood sugar screenings is important to catch previously undiagnosed blood sugar issues.
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