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Overview of Diabetes Mellitus Type 1 and Type 2

Being a caregiver for or someone who has diabetes can be challenging. You may have heard terms like diabetes mellitus (type 1 diabetes mellitus and  type 2 diabetes mellitus), diabetes insipidus, diabetic emergencies, gestational diabetes, insulin, or blood glucose (sugar)  monitoring, but what does that all mean? Diabetes can lead to serious health complications, but you may be able to manage the condition with medications and lifestyle changes. Understanding the symptoms of diabetes, what complications to look for, and what the treatment is will help you better manage the condition. Due to the blood’s raised glucose levels, people with diabetes have to monitor their condition carefully because uncontrolled blood glucose can lead to severe medical conditions.  Therefore, it is crucial to understand some vital information about diabetes and how it is managed.

What is Insulin?

Our pancreas excretes insulin into our bloodstream.

Insulin is a hormone that enables blood sugar to enter your cells. This blood sugar provides cells the energy needed to function.

Insulin also lowers the amount of glucose (sugar) in your bloodstream. As the amount of glucose drops in your blood, the pancreas reduces the secretion of insulin.

 

If there is too little or too much insulin produced, excessive high or low blood glucose levels will likely cause symptoms.

If low or high blood glucose levels continue for some time, it may result in serious medical problems.

That is why it is important to maintain healthy blood glucose levels.

 

A lack of effective insulin is a key factor in developing diabetes.

 

doctor holding heart with text diabetes

 

 

What is Diabetes Mellitus?

Diabetes mellitus refers to medical conditions that affect how your body uses glucose, also called blood sugar.

Blood glucose is critical because it is a source of energy for tissue and muscle cells, and it’s the primary source of fuel for our brain.

Diabetes mellitus is categorized into type 1 diabetes and type 2 diabetes. We review the differences between type 1 and type 2 diabetes below.

 

If you have diabetes, it could lead to excess glucose in your blood, leading to severe health issues. Therefore, it is a good idea to understand what it is, and how to manage and treat it. 

 

 

Types of Diabetes Mellitus

Sometimes people may be told they have prediabetes, which means their blood glucose is high but not enough to be diagnosed with diabetes.

If you are prediabetic, there are measures one can take to help prevent progression.

 

Both type 1 and 2 diabetes are the two major categories of diabetes mellitus, and both are a result of malfunctions in the hormone insulin.

 

 

 

 

young female with diabetes mellitus high blood sugar injecting insulin with needle into her arm

Type 1 Diabetes Mellitus

Type 1 diabetes mellitus is sometimes referred to as insulin-dependent diabetes or juvenile diabetes.

It is a chronic medical condition that occurs when our body  (the pancreas) makes little or no insulin.

Insulin is a hormone we need to allow glucose (sugar) into our cells to produce energy.

It is most commonly found in childhood or adolescence, but it can develop at any age.

 

 

What Causes of Type 1 Diabetes Mellitus? 

We do not know the cause of type 1 diabetes mellitus, but we know your immune system attacks and may destroy cells in the pancreas. Keep in mind, the pancreas is where the insulin is made.

Thus, you have either very little, or no insulin left. Because you do not have enough insulin to transport the blood sugar into your cells, the glucose builds up in your blood.

High glucose levels can lead to disorders of the nervous, circulatory and immune systems.

Although we don’t know the cause of type 1 diabetes, different factors may contribute to it, for example genetics or some viruses.

 

There is no cure for type 1 diabetes. Treatment focuses on managing blood glucose levels with insulin, and also a healthy diet and lifestyle to prevent complications. 

 

Diagnosing Type 1 Diabetes Mellitus

Health care providers usually test anyone who has symptoms of diabetes or may be at risk for it.

Blood tests used to help diagnose diabetes mellitus include:

  • The A1C test provides a good picture of your blood glucose levels over the past two to three months.  It looks at the percent of blood glucose attached to oxygen carrying protein in your hemoglobin.  The higher your blood glucose, the more hemoglobin you’ll have with glucose attached. If your A1C level is 6.5 percent or more on two separate tests, it indicates diabetes.
  • If the A1C test is not available, your doctor may check the fasting plasma glucose (FPG) test or random blood sugar test. Both are blood tests that look at blood glucose levels.
  • Your provider may also check your blood for some autoantibodies that are common in type 1 diabetes.
  • In addition, they may check your urine for ketones (byproducts of fat breakdown) which usually indicates type 1 rather than diabetes type 2.

 

Risk Factors for  Type 1 Diabetes Mellitus

An exact cause for type 1 diabetes mellitus is not known, and the risk factors for type 1 is not as clear as they are for type 2 diabetes.

However you are more likely to have diabetes mellitus type 1 if:

  • Age: Although you can get diabetes type 1 at any age, children, teens and younger adults are more likely to develop it
  • Family History: If you have a parent or sibling with diabetes type 1, your risk increases
  • In the United States, white people are more likely to develop type 1 diabetes type 1 compared to Hispanic/Latino Americans or African Americans

 

 

doctor taking finger stick woman hand

Treatment for Diabetes Mellitus Type 1

Lifestyle changes such as healthy eating, engaging in physical activity, and losing weight may help control type 1 diabetes. Additionally, doctors prescribe insulin to treat type 1 diabetes.

Insulin will usually be the treatment for type 1 diabetes because you need to replace the hormone (insulin) that your body cannot produce.

 

Providers prescribe four main types of insulin, differentiated by 1)  how fast they begin to work and also  2) how long the effects last.

  • Rapid-acting insulin begins working within 15 minutes, and the effects will usually last for 3 to 4 hours.
  • Short-acting insulin begins working within 30 minutes, and the effects will usually last 6 to 8 hours.
  • Intermediate-acting insulin begins working within 1 to 2 hours, and the effects will usually last 12 to 18 hours.
  • Long-acting insulin begins working within a few hours after injection, and the effects will usually last 24 hours or longer.

 

Symptoms of Diabetes Mellitus Type 1

Diabetes symptoms can vary among people and depend on how much your blood glucose is elevated. Additionally, those with type 1 diabetes can have severe symptoms that can begin quickly.

 

Common signs and symptoms of type 1 diabetes include:

  • Frequent urination
  • Increased thirst
  • Extreme hunger even though you eat
  • Blurry vision
  • Fatigue
  • Unexplained weight loss
  • Dry Mouth
  • Bed-wetting for children who usually don’t
  • Cuts and bruises that heal slowly

 

doctor sitting arms folded on table diabetes type 1 testing blood sugar strip

What are the Complications of Type 1 Diabetes Mellitus?

High blood sugar levels damages tissues and organs throughout your body. The higher your glucose levels and the longer you have diabetes, the greater your risk for complications.

 

Complications associated with diabetes may include:

  • Heart attack, heart disease, and stroke. Your risk also increases for conditions such as atherosclerosis and angina.
  • Neuropathy (Nerve damage).  High blood sugar levels can eventually damage the small blood vessels that nourish your nerves, which can cause numbness, tingling, a burning sensation, or pain. This is commonly found in toes and fingertips, and if you do not treat it, you could lose feeling.
  • Kidney damage (nephropathy). Our kidneys filter the waste in our blood, and diabetes can damage this, leading to kidney failure and possibly end-stage kidney disease.
  • Eye damage (retinopathy) and vision loss. Diabetes can injure the blood vessels in our eye (diabetic retinopathy), increasing the risk of glaucoma, cataracts, or being blind.
  • Foot damage. Diabetic patients are cautioned to monitor their feet because poor blood flow or nerve damage in your feet can cause problems. Cuts, blisters, and wounds can heal poorly and develop infections which may ultimately result in an amputation.
  • Skin Problems. Diabetes may put you at risk for skin conditions, including fungal and bacterial infections.
  • Hearing loss or impairment. People with diabetes tend to have more hearing problems than people without diabetes.
  • Dementia. Studies have shown that Type 2 diabetes may increase your risk of dementia.
  • Depression. Depression symptoms are common in people with diabetes, and depression can impact the management of diabetes.

 

Managing Type 1 Diabetes 

Your health care provider should advise you on how to manage your diabetes best. Lifestyle changes may be recommended. Most diabetics must monitor their blood glucose levels, and your health care provider will give guidance on what to do depending on what your glucose levels are.

 

Blood Glucose Monitoring

Regular blood glucose monitoring is essential for someone with diabetes.

The blood glucose of a diabetic patient is monitored by a glucometer, commonly where the drop of blood is put on a monitoring strip and placed in the glucometer to get a glucose reading.

The glucometer gives you a reading which tells you the glucose levels in your blood.

 

Routinely monitor your medication and supplies, and make sure to reorder before they get too low.  Anticipate delays at the pharmacy, for example because a prescription needs to be renewed by your provider or the insurance company may need to review the prescription for approval.

 

To easily manage important health information including blood sugar levels, download our FREE tracker tools that help you monitor common chronic conditions:

Blood Sugar Log, Simple

Blood Sugar Log, Complex

Medication Log Tracker

Blood Sugar, HR, Wt., BP Log

Emergency Contact Sheet

 

Diabetic Emergencies – Diabetes Mellitus Type 1

Diabetes symptoms may suddenly turn into a diabetic medical emergency.

It is crucial to recognize the signs and symptoms of a diabetic emergency and know how to respond to one.

 

For example, two diabetic emergencies include:

1. Hypoglycemia

Hypoglycemia is when the blood sugar is too low and if untreated can be life-threatening.

Low blood sugar, can happen if you exercise more than usual, drink alcohol, skip a meal, or take too much insulin.

Early signs include hunger and shakiness. It’s important to treat hypoglycemia quickly so it doesn’t get severe.

Severe hypoglycemia causes confusion, blurry vision, seizures, passing out, and also can lead to diabetic coma.

It is important to monitor your blood sugar so you don’t get hypoglycemia, and worse, end up with a medical emergency.

 

2. Hyperglycemia

Hyperglycemia, on the other hand, is when the blood glucose levels are too high.

High glucose levels can lead to life-threatening conditions such as  hyperglycemic hyperosmolar syndrome or diabetic ketoacidosis.

Diabetic ketoacidosis is also called DKA, and is a life-threatening emergency.

When your body doesn’t have enough insulin, your liver will break fat into ketones for energy.

DKA is when this breakdown happens too fast and there is a buildup of ketones that can alter blood chemistry and poison you.

You could go into a coma.

Causes include infection, being sick, stress and some medicines.

You may also notice dry mouth, extreme thirst, frequent urination, fruity smelling breath among other symptoms.

 

 

 

 

 

lady with diabetes type 2 taking blood sugar with finger stick and glucose monitor because she has Diabetes Insipidus

 

Type 2 Diabetes Mellitus

Type 2 diabetes mellitus is also referred to as adult-onset diabetes because it is more common in older adults (but can occur in children).

It is an impairment in the way the body regulates and uses sugar (glucose) as a fuel.

 

There are two interrelated problems with type 2 diabetes.

Your pancreas does not make enough insulin (the hormone that regulates moving sugar into your cells) and your cells respond poorly to insulin and pull in less sugar.

Eventually this results in the accumulation of sugar in the bloodstream.

High blood sugar levels can lead to disorders of the circulatory, nervous and immune systems.

This is a chronic condition and more common in people who are over 45 years old.

What Causes Type 2 Diabetes? 

In type 2 diabetes mellitus, your cells become resistant to your insulin, and the pancreas cannot make enough insulin to overpower this.

Thus, the blood sugar cannot move into the cells needed for energy; instead, it builds up in your blood.

There is a significant link between being overweight and having type 2 diabetes.

 

There isn’t a cure for type 2 diabetes mellitus, but losing weight, eating well, exercising and maintaining a healthy weight will better manage the disease.

If a healthy lifestyle is not enough to control you blood sugar, your provider will likely prescribe medication.

Diagnosing Type 2 Diabetes Mellitus

Doctors usually test anyone who has symptoms of diabetes or those who may be at risk.

Blood tests used to help diagnose diabetes mellitus include:

  • The A1C test is commonly used to diagnose diabetes type 2. It reveals the percent of blood glucose attached to the oxygen carrying protein in the hemoglobin.  The higher your blood glucose level, the more hemoglobin you have with glucose attached. If your A1C level is 6.5 percent or higher on two separate tests, it indicates diabetes. If your results are 5.7% to 6.4%, it indicates a prediabetes diagnosis. Normal values are levels below 5.7%.
  • If the A1C test is unavailable, your provider may check the fasting plasma glucose (FPG) test or order a random blood sugar test. Both blood tests look at blood glucose levels.
  • Less commonly used is the oral glucose tolerance test, however it is used during pregnancy.  For this test you drink a sugary drink during the office visit and then your blood levels are checked periodically over two hours.

 

Risk Factors for Diabetes Mellitus Type 2

The following factors signal an increased risk of diabetes mellitus type 2:

  • Weight: The main risk for type 2 diabetes is being overweight or obese.
  • Age: Your risk increases as you get older, especially for those who are 45 years old or older.
  • Family history: If a sibling or a parent has diabetes, your risk increases.
  • Fat distribution: Those who store fat mainly in the abdomen (instead of hips or thighs) have a higher risk, especially for men with a waist over 40 inches or females with a waist over 35 inches.
  • Inactivity: Those who are not physically active have a higher risk of type 1 diabetes.
  • Those with prediabetes or gestational diabetes.
  • Those with high numbers: high cholesterol or high triglycerides.
  • Race and ethnicity, the following have higher risk: Hispanic/Latino, African American, Native Hawaiian, Pacific Islander, Alaska Native, Asian, or Native American.

 

 

blood sugar tracker and monitor and healthy food type 2 diabetes treatment

 

Treatment for Type 2 Diabetes

  • A healthy lifestyle that includes physical exercise, a healthy diet and weight management can help better manage type 2 diabetes. If lifestyle changes aren’t enough to keep your blood sugar within normal limits, you may need to take medication in addition to implementing healthy lifestyle changes.
  • There are a variety of drugs to lower your blood sugar, and they work in different ways.  For example, Metformin helps to reduce the amount of glucose your liver makes, Sulfonylureas helps the body secrete more insulin, and Glinides stimulates the pancreas for better insulin production. There are numerous different types of medications to help manage diabetes, and some people may need more than one of these drugs. If glucose levels are not managed with lifestyle changes and oral medications, insulin may be prescribed.

It is essential to work with your health care team to monitor your critical health numbers, including weight, blood sugar levels, and cholesterol.

 

Symptoms of Diabetes Mellitus Type 2

Diabetes symptoms can vary among people and depend on how much your blood glucose is elevated. Those with prediabetes and type 2 diabetes may experience mild symptoms or may not notice them.

 

Common signs and symptoms of diabetes type 2 include:

  • Frequent urination
  • Increased thirst
  • Extreme hunger, even though you eat
  • Blurry vision
  • Fatigue
  • Slow-healing cuts or sores
  • Tingling or numbness in the feet or hands
  • Unexplained weight loss

Early detection and treatment of diabetes can decrease the risk of developing  complications of diabetes.

 

 

What are the Complications of Diabetes Type 2?

Elevated blood sugar levels damages organs and tissues throughout your body. Diabetes can affect blood vessels, heart,  nerves, eyes, and kidneys. The higher your glucose levels and the longer you have diabetes, the greater the risk for complications.

 

Complications associated with diabetes may include:

  • Heart disease, heart attack, stroke and blood vessel disease. In addition, your risk increases for conditions such as atherosclerosis and angina.
  • Neuropathy (Nerve damage).  High sugar levels may damage small blood vessels, which nourish the nerves. This can cause a burning sensation, tingling, numbness, or pain. This is usually seen in fingertips and toes, and if untreated you can lose feeling in the limb.
  • Kidney damage. Our kidneys filter the waste from our blood. Diabetes can lead to kidney failure and possibly end-stage kidney disease.
  • Eye damage and vision loss. Diabetes can injure the blood vessels in our eye , called diabetic retinopathy. This can lead to eye conditions such as cataracts, glaucoma and possibly lead to blindness.
  • Foot damage. Diabetics are cautioned to monitor their feet because poor blood flow or nerve damage in your feet can cause problems. For example, cuts and wounds can heal poorly and develop infections which may ultimately result in an amputation.
  • Skin Problems. Diabetes may put you at risk for skin conditions, including slow healing cuts and bacterial infections.
  • Hearing loss or impairment. People with diabetes tend to have more hearing problems than people without diabetes.
  • Dementia. Studies have shown that Type 2 diabetes may increase your risk of dementia.
  • Depression. Depression symptoms are common in people with diabetes, and depression can impact the management of diabetes.

 

Managing Type 2 Diabetes Mellitus 

Your doctor should let you know how to manage your diabetes.  Ask questions if you are not clear on something. Lifestyle changes may be recommended. Most diabetic have to monitor their blood glucose levels, and your health care provider will give guidance on what steps to take depending on your levels.

Blood glucose monitoring is critical for effective diabetes management.  A glucometer helps monitor blood glucose, where commonly a drop of blood is put on a monitoring strip and placed into the glucometer to get a blood sugar reading. 

It’s a good idea to carefully monitor your medication and supplies, and reorder before you get too low.  Sometimes there may be a pharmacy delay, for example due to an insurance review or because your doctor needs to send a renewal order to the pharmacy.

To easily manage your important health information,  download our FREE tracker tools:

Blood Sugar, HR, Wt., BP Log

Medication Log Tracker

Blood Sugar Log, Simple

Blood Sugar Log, Complex

Emergency Contact Sheet

 

Diabetic Emergencies – Diabetic Mellitus Type 2

Diabetes symptoms can turn into a diabetic medical emergency.

It is important to recognize the signs and symptoms of a diabetic emergency and also know how to respond.

For example, three diabetic emergencies include:

1. Hypoglycemia (Low Blood Glucose Levels)

Hypoglycemia is low blood sugar and if untreated can be life-threatening.

It can occur if you skip a meal, exercise more than usual, drink alcohol, or if you take too much insulin.

Early signs of hypoglycemia include hunger and shakiness.

It is important to treat hypoglycemia right away so it doesn’t get severe.

Severe hypoglycemia causes blurry vision, confusion,  seizures, passing out, and can possibly lead to diabetic coma.

It is crucial to monitor your blood glucose so you don’t get hypoglycemia and end up with an emergency.

2. Hyperglycemia (High Blood Glucose Levels)

Hyperglycemia is when your blood glucose level gets too high.

High sugar levels can also lead to life-threatening conditions such as  hyperglycemic hyperosmolar syndrome or diabetic ketoacidosis.

Diabetic ketoacidosis (also called DKA) occurs when your body doesn’t have enough insulin, and your liver breaks fat into ketones for energy too fast.

DKA is when this breakdown happens too fast and there becomes a buildup of ketones that alters blood chemistry and can poison you.

You could go into a coma.

Some causes include being sick, infection, stress and some medicines.

You may notice frequent urination, extreme thirst, dry mouth, fruity smelling breath or other symptoms.

3. Hyperosmolar Hyperglycemic Nonketotic Syndrome

Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHS or HHNS):  HHS is a short-term complication that may occur in people with non-insulin dependent diabetics, like type 2 diabetes, if blood sugar levels rise to a very high level.

It is  more commonly seen in older people with uncontrolled glucose levels who are sick or with an infection.

As the blood glucose rises (over days, maybe weeks) the body tries to get rid of the extra sugar through increased urination.

If not drinking enough fluids, they get extreme dehydration and can get HHS which can cause coma, seizures and possibly death.

There are many symptoms, including dry mouth, fast heart rate, cool hands and feet, frequent or dark urine, confusion, warm skin without sweat, slurred speech, and one-sided weakness.

 

 

 

 

 

male doctor sitting with female patient discussing healthcare

 

 

What is Diabetes Insipidus?

Although diabetes mellitus and diabetes insipidus sound similar, they are not related.

While diabetes mellitus is a medical condition that affects how your body uses blood glucose, diabetes insipidus is an uncommon disorder that causes your kidneys to remove too much fluid from your body.

The cause of diabetes insipidus will depend on the type you have.

For example, central diabetes insipidus is caused by damage to the hypothalamus or pituitary gland, while nephrogenic diabetes insipidus is usually caused by a problem in your kidney tubules.

With diabetes insipidus, your body can’t balance your body’s fluid levels, so you frequently feel very thirsty even though you have been consuming enough fluids.

You also urinate significantly more than someone who does not have this condition.

 

 

 

 

gestational diabetes pregnant woman with blood glucose monitor

 

What is Gestational Diabetes?

Hormonal changes and fluctuations that occur during pregnancy may cause gestational diabetes.

This is because the placenta produces hormones that may make the pregnant woman’s cells less sensitive (than usual) to the effects of insulin.

This may cause high blood sugar levels during pregnancy.

Women who gain more than the normal pregnancy weight or who may have been overweight before they got pregnant are at a higher risk of getting gestational diabetes.

 

Uncontrolled gestational diabetes can cause problems for both the baby and the mother.

 

Complications for the baby may include:

  • A higher birth weight
  • Premature birth
  • Jaundice
  • Increased risk of them getting type 2 diabetes later on in life
  • Stillbirth
  • Low blood sugar

 

Complications to the mother can include preeclampsia (high blood pressure), the need for a cesarean delivery (C-section)  or developing type 2 diabetes.

To check for Gestational Diabetes, pregnant women usually have their blood glucose levels tested between the 24th and 28th weeks of pregnancy.

  • In the glucose challenge test, an hour after drinking a sugary liquid, your blood glucose is checked.
  •  The 3-hour glucose tolerance test checks your blood glucose when you drink a sugary liquid after fasting overnight.

 

 

 

 

              Comparing Diabetes Mellitus, Diabetes Insipidus & Gestational Diabetes

              type 1 diabetes type 2 diabetes gestational diabetes diabetes Insipidus

 

home care nurse helping senior woman

ADDITIONAL INFORMATION:

 

Home Care Services

Home care includes a variety of professional support services that allow a person to stay in their home safely. Professionals, for example, a registered nurses,  may provide care in the home, depending on your needs.

Home care services can help someone who is:

  • managing illness, injury, or serious medical conditions;
  • recovering from a hospitalization or a medical procedure; or
  • has a disability or other special needs.

For additional information on home health care, including types of home care services, please read our blog post Understanding Home Health Care.

 

Stress & Self Care

Recognizing and managing stress can help your physical and emotional well-being. Stress can do harm to your body, so it is important to manage it, especially if you have other medical conditions. For information about stress, how it impacts your health, and how to manage it, please read our blog post What is Stress? 

 

 

Where to Find Help

There are local resources that may alleviate some burden from you or your loved one. Some local communities offer resources that may help such as low or no-cost meal delivery programs, caregiver resources, health insurance consultation, assistance with housing or utilities, visiting nurses, or respite care programs. For a comprehensive list to help find local community resources, please read our post Senior Resources- Guide for Caregivers.

 

 

 

 

Conclusion

Diabetes mellitus type 1 and type 2 can cause life-threatening complications if not managed effectively. Therefore, it is crucial to understand your diagnosis, the role of insulin, how to monitor your blood glucose and watching for symptoms. Maintaining a healthy lifestyle and following the treatment plan can also decrease the chances of complications.

 

 

 


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