Introduction to Diabetes Diabetes is a collection of metabolic disorders that result in high amounts of sugar in the blood.  Elevated blood sugar is known as hyperglycemia and is the key element in the diagnosis of Diabetes. The main forms of diabetes include type 1, type 2, and gestational. Some forms of diabetes can be cured or prevented with lifestyle changes such as early stage type 2, while others are chronic such as type 1. Diabetes occurs either due to lack of insulin being produced by the pancreas or lack of the body’s response to insulin. Glucose, which is a form of sugar that is used as energy by the body, cannot enter the cell without insulin. Thus when insulin is not being used or produced properly the sugar stays in the blood stream causing high blood sugar. Chronic elevations in blood sugar over time lead to complications in the vascular systems of the kidneys, heart, eye, feet, nerves, and significantly increases risk for heart disease and stroke. Metabolic disorder: A condition that occurs due to a dysfunction in one or many of the pathways that control metabolism. Metabolic pathways control the ways in which the body produces energy and eliminates waste.

Type I Diabetes Type I Diabetes is much less common than type II, accounting for only 5-10% of diabetes cases. Diabetes type 1 is typically diagnosed before the age of 30. Type I Diabetes is an autoimmune disease in which the beta cells (insulin producing cells) located in the pancreas are destroyed over a period of time. The more beta cells are destroyed the less insulin that can be made. This results in a lifelong deficiency of insulin and dependency on insulin from external sources. Autoimmune refers to a condition in which the body mistakes its own cells (the beta cells) for invader cells and destroys them. While the exact cause is unknown, the autoimmune process is thought to be the result of genetic predisposition and an environmental trigger. This event sets off a chain reaction that causes the B cells of the immune system to creates proteins called antibodies that mark the beta cells and signal for their destruction by other parts of the immune response team. The CD4 and CD8T Cells are the soldiers who sniff out and destroy the tagged beta cells Progression of Type I Diabetes Pre-Diabetes: The hallmark of pre-diabetes is the presence of GAD, ICA, IAA antibodies. In addition there will be evidence of beta cell injury and a decrease in the amount of insulin being produced.

While patients may be tested for diabetes due to a variety of reasons, the guidelines suggest the following groups be tested People who are overweight and have one or more risk factors Overweight adults include people with a BMI >25 kg/m Risk factors (link to risk factors tab) People who have signs of high blood sugar (link to HBS tab) People with several risk factors Women who are pregnant Confirming a Diabetes diagnosis will be based on one of the following lab values: A1c levels of 6.5% or higher indicate diabetes OR Fasting plasma glucose (FPG) > 126mg/dL OR 2-hour plasma glucose level of >200mg/dL during an oral glucose tolerance test using glucose load containing the equivalent to 75g of glucose dissolved in water OR Classic symptoms of hyperglycemia (polyuria, polydipsia, polyphagia) or hyperglycemic crisis, with a random plasma glucose of >200 mg/dL

High blood sugar is known as hyperglycemia and occurs when the amount of sugar in the blood is elevated. A blood sugar of more than 130 mg/dl is considered abnormal. While people with diabetes are at higher risk for hyperglycemia, not all people who have hyperglycemia will have diabetes. Causes of High Blood Sugar Too much food Not enough Insulin Stress Medications Normal Response to High Blood Sugar: When the amount of sugar in the blood is elevated the body signals the pancreas to secrete insulin. Insulin facilitates the transport of sugar into the cells to be used for immediate energy and storage of excess sugar in the liver and muscles for later use. Recommended Read:  Foods to Eat When You Have Low Blood Sugar Dangerously High Blood Sugar: When blood sugar levels become dangerously high it is considered a medical emergency and immediate medical attention is needed. Do not wait until your blood sugar is dangerously high to call your doctor. Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome can cause dangerously high blood sugar. Diabetic Ketoacidosis: A potentially life-threatening condition that results from a lack of insulin and elevated blood glucose. Since glucose is not being used for energy the body begins to break down fats which lead to ketoacidosis.

Low blood sugar is known as hypoglycemia and occurs when the amount of sugar (glucose) in the blood is low. A blood sugar of less than 70mg/dl is considered abnormal or low. While people with diabetes are at higher risk for hypoglycemia, due to effects from diabetes medications, not all people who have hypoglycemia will have diabetes. Causes of Low Blood Sugar Not enough food (glucose) Long periods of time between meals (>3-5 hours) Too much insulin Too much diabetes medications Strenuous exercise Illness Normal Response to Low Blood Sugar When the amount of sugar in the blood is low, the body will send signals to the pancreas indicating that the sugar is decreasing. The pancreas, in turn, signals the liver to break down the stored glucose in the liver and as a result blood sugar rises. In addition, physiological symptoms such as hunger and fatigue will be experienced, which is your body’s way of telling you that it is time to eat. Symptoms of Low Blood Sugar Hunger Fatigue and drowsiness Confusion Dizziness Shakiness Rapid Heart rate Blurred vision Mood changes and Irritability In extreme cases of low blood sugar, the person may experience loss of consciousness or have seizures Treatment for Low Blood Sugar: