Diabetes Mellitus: Types, Symptoms and Causes

Diabetes mellitus is a chronic disease that is becoming more prevalent worldwide. There are several different types and causes of diabetes.

Diabetes causes high blood sugar, which is harmful to health. As of 2015, 30.3 million people in the United States, or about 9.4 percent of the population, had diabetes.

Unfortunately, more than 1 in 4 people with diabetes don’t know they have it.

Having undiagnosed diabetes increases the risk of diabetes-related complications such as kidney disease, heart disease, amputations, and more.

The majority of people with diabetes have type 2, which typically affects older adults and can be related to multiple known risk factors, including race, weight, and some lifestyle factors. Type 1 diabetes is rarer as it’s an autoimmune disorder.

Type 1 usually occurs before age 18, which is why it’s also referred to as juvenile diabetes. Moreover, type 1 diabetes affects about 2-5% of the world’s population or about 1 in 300 American adults before the age of 18. 

As discussed above, there are several different types of diabetes, each with a unique set of symptoms and complications. In this article, we will discuss each type and the causes behind them.

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What is diabetes?

Diabetes mellitus, or diabetes, is a disease affecting the regulation of blood glucose (sugar) levels. An organ called the pancreas creates the hormone insulin, which helps keep blood sugar levels in a healthy range.

With diabetes, the pancreas either doesn’t make enough insulin, or the body doesn’t respond to it well. Without proper insulin function, blood sugar levels rise and can lead to health problems if left untreated.

Treating diabetes takes a significant economic toll, with an estimated cost of $327 billion spent in 2017 to treat diabetes. Diabetes can cause many other health problems, further increasing healthcare costs.

Diabetes Complications

Some of the complications from chronic diabetes can 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 can cause painful symptoms like numb and tingling legs and feet, as well as delayed stomach emptying from damage to the stomach nerves.

  • Retinopathy and blindness: Damage to the nerves in the eyes is called retinopathy, leading to blindness if not treated.

While diabetes is a serious disease, the chance of diabetes complications can be reduced with proper management of blood sugar levels.

You can treat diabetes with lifestyle changes, medications, and other aspects of a good diabetes management plan.

What is type 1 diabetes?

Type 1 diabetes is an autoimmune disease where the immune system mistakenly views the pancreas’ beta cells as foreign invaders.

An autoimmune condition is one in which the immune system mistakenly attacks the body’s own cells. The beta cells are responsible for producing insulin, which helps keep blood sugar levels in a healthy range.

In type 1 diabetes, the immune system attacks these cells, leading to their destruction. The result is that the pancreas then can’t produce enough insulin to keep blood sugar levels from rising too high. 

The process of the beta cells being destroyed can take years before symptoms arise, which makes it hard to salvage any beta-cell function by the time of diagnosis.

This is why type 1 diabetes is referred to as “insulin-dependent” diabetes – the pancreas creates very little to no insulin, thus requiring injectable insulin and sometimes insulin pumps.

Symptoms of type 1 diabetes

  • Increased thirst

  • Frequent urination

  • Bed-wetting in children who previously didn’t wet the bed during the night

  • Extreme hunger

  • Unintended weight loss

  • Irritability and other mood changes

  • Fatigue and weakness

  • Blurred vision

Risk Factors

The risk factors for type 1 diabetes aren’t as well-understood as the other types of diabetes because of its nature as an autoimmune disease.

Some known 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: specific 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.

  • Viruses: Certain viruses have been associated with the development of type 1 diabetes, including Coxsackievirus B, rotavirus, mumps, and cytomegalovirus. Some viruses may also offer preventative benefits against type 1 diabetes as well.

What is type 2 diabetes?

Type 2 diabetes isn’t an autoimmune disease, and its risk factors are more well-known than type 1. The risk factors for type 2 diabetes tend to be more related to lifestyle habits such as being inactive, being overweight, etc.

Type 2 diabetes usually affects adults (being over the age of 45 is a risk factor), but unfortunately, it is becoming more prevalent in younger people. Due to the increase in childhood obesity, more children are getting type 2 diabetes as young as the age of ten.

Type 2 diabetes is usually caused by insulin resistance, which is when the body doesn’t use insulin the way it should. When the body “resists” insulin, the pancreas increases the amount of insulin it’s producing to help reduce blood sugar levels.

This can lead to the pancreas being overworked, which can eventually lead to its inability to create enough insulin to keep blood sugar levels in balance

People with type 2 diabetes usually have some pancreatic function left, so they can be treated with lifestyle changes and medications besides insulin. However, over time the remaining pancreatic function can decline, leading to insulin reliance as a treatment. 

Symptoms of type 2 diabetes

Symptoms of type 2 diabetes are similar to those of type 1 and include:

  • 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 the kidney absorbing less water and the bladder excreting more. 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 connects 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:  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.

Risk Factors

Risk factors for 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 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, American Indian, 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 who 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.

Some of the most common risk factors for developing type 2 diabetes are low physical activity and being overweight. However, people not considered to be overweight can also develop type 2 diabetes.

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What is gestational diabetes?

Gestational diabetes (GDM) occurs specifically during pregnancy and often resolves after pregnancy. Hormonal changes in pregnancy can trigger insulin resistance, which is the leading cause of GDM.

People with gestational diabetes are at increased risk of developing type 2 diabetes later in life even though their blood sugars will usually return to normal after giving birth.

Gestational diabetes is usually diagnosed between the 24th and 28th weeks of pregnancy.

Symptoms

The signs and symptoms of gestational diabetes are similar to those of type 1 and type 2 diabetes and include:

  • Increased thirst

  • Frequent urination

  • Dry mouth

  • Fatigue

  • Sugar in the urine

Precedence of gestational diabetes

Gestational diabetes affects between 2-10% of pregnancies in the United States. It is usually managed by the mother’s healthcare provider as well as other specialists such as dietitians and diabetes educators.

Sometimes women with gestational diabetes will be referred to a provider who specializes in high-risk pregnancies since a woman with GDM is considered high-risk.

Gestational diabetes risk factors

Risk factors for developing gestational diabetes mellitus include:

  • Being at a higher weight when becoming pregnant.

  • Being African-American, Asian, Hispanic, or Native American

  • Having a history of prediabetes or previous pregnancy with GDM

  • Having high blood pressure or other medical problems

  • Giving birth to a large baby weighing 9 pounds or more

  • Having given birth to a stillborn baby or one with birth defects

  • Being over the age of 25

Complications and risks

GDM has risks for both mother and baby, which is why controlling blood sugar levels during pregnancy is a high priority.

Some risks of gestational diabetes include:

  • Excessive birth weight. Higher than normal blood sugar in mothers can cause their babies to grow too large, increasing the risk of complications like shoulder dystocia and the need for a cesarean section (C-section).

  • Early (preterm) birth. High blood sugar may increase the mother’s risk of early labor and delivery before the due date. 

  • Serious breathing difficulties. Babies born early to mothers with gestational diabetes may experience respiratory distress syndrome, which makes breathing difficult.

  • Low blood sugar (hypoglycemia). Sometimes babies of mothers with gestational diabetes have low blood sugar (hypoglycemia) shortly after birth.

  • Obesity and type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.

  • Stillbirth. Untreated, gestational diabetes can result in a baby’s death either before or shortly after birth.

What is prediabetes?

Prediabetes is a condition where blood sugars are slightly elevated but not high enough to be considered diabetes. Having prediabetes is a significant risk factor for eventually developing type 2 diabetes.

The U.S. Centers for Disease Control (CDC) estimates that up to 30% of people with prediabetes will develop type 2 diabetes within five years of their prediabetes diagnosis.

Symptoms of prediabetes

One of the challenges with prediabetes is that it is often asymptomatic for the majority of the time you might have it.

Since it has no obvious symptoms, it often goes undetected until serious health problems show up.

One possible sign of prediabetes is dark patches of skin on certain parts of your body. This can occur on the neck, armpits, elbows, knees, and knuckles.

Risk Factors

  • Age

  • Family history

  • Race/ethnicity

  • Sleep patterns

  • Long term stress

  • Metabolic syndrome

  • Polycystic ovary syndrome (PCOS)

  • Gestational diabetes

  • Steroids

  • Lack of physical activity

  • Unhealthy eating/ poor dietary habits

  • Sedentary lifestyle / Lack of regular exercise

  • Being overweight or obese

Other diabetes causes

Latent Autoimmune Diabetes in Adults (LADA) is often misdiagnosed as type 2 diabetes at first, but it is more like type 1 than type 2.

It is often misdiagnosed at first because it impacts adults, whereas type 1 diabetes typically presents during childhood and teenage years (juvenile-onset diabetes). This is what we call type 1.5 diabetes.

Some tests that can help differentiate LADA from type 2 include specific antibody tests, including C-peptide, IAA, IA-2A, ZnT8Ab, ICA, GADA, or anti-GAD. 

Another subset of type 1.5 diabetes is MODY, which stands for “maturity-onset diabetes of the young” and is quite rare. It’s a form of monogenic diabetes, which is caused by a gene mutation. It can impact infants, adolescents, and young adults, whereas LADA usually shows up in adults over the age of 30.

Some other rarer causes of diabetes include:

  • Wolfram Syndrome: Also called DIDMOAD (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness), this rare genetic disorder in children under the age of 6. Unfortunately, the life expectancy for people with this condition is only 30 years due to its many complications.

  • Cystic Fibrosis-related diabetes: Cystic Fibrosis is a genetic disease causing thick mucus to accumulate in the lungs, pancreas, and other organs. The mucus can damage the pancreas and lead to scarring, which then inhibits its ability to produce insulin.

  • Chronic pancreatitis-related diabetes: Pancreatitis is the inflammation of the pancreas, the organ responsible for producing insulin. When pancreatitis is chronic, it can lead to diabetes.

Conclusion

Diabetes is a chronic disease leading to elevated blood glucose (sugar) levels. It’s becoming more prevalent and can impact people of any age.

High blood sugar levels can cause health problems such as heart disease, kidney disease as well as many other health problems, so controlling blood sugar levels is vital in helping to avoid these devastating complications.

There are many different kinds of diabetes, including type 1, type 2, gestational, and more rare forms of autoimmune- and genetic-related diabetes.

No matter the type of diabetes, the root cause is the destruction of cells in the pancreas responsible for producing insulin. Insulin is a hormone necessary for lowering blood sugar levels, and without adequate amounts, diabetes can develop.

The risk factors for type 2 diabetes are more well-known and include aspects such as lifestyle habits, weight, ethnicity, smoking status, and more.

On the other hand, the causes of type 1 diabetes and the other autoimmune disease-related forms of diabetes are less well-known.

So, more research is being done all the time to help identify potential risk factors and other causes to try to reduce the incidence of these rarer types of diabetes.

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Sources

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  2. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes
  3. https://www.cdc.gov/diabetes/basics/gestational.html
  4. https://www.diabetes.co.uk/symptoms/unexplained-weight-loss.html
  5. https://www.heart.org/en/health-topics/diabetes/why-diabetes-matters/cardiovascular-disease–diabetes
  6. Economic Costs of Diabetes in the U.S. in 2017 American Diabetes Association
    Chen R, Ovbiagele B, Feng W. Diabetes and Stroke: Epidemiology, Pathophysiology, Pharmaceuticals and Outcomes. Am J Med Sci. 2016;351(4):380-386. doi:10.1016/j.amjms.2016.01.011
  7. https://www.ajmc.com/newsroom/diabetic-amputations-may-be-rising-in-the-united-states
Alternative Text

Diana Gariglio-Clelland (RD)

Diana Gariglio-Clelland obtained her B.S. in Nutrition from the University of Idaho and is a Registered Dietitian with experience in the hospital, community and primary care health settings.

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