What Is Diabetes?
You’ve been diagnosed with diabetes because there is
too much glucose (a kind of sugar) in your blood. Glucose comes from the
starches and sugars that you eat. (However, diabetes is not caused by eating
too much sugar.) Your muscle and fat cells use glucose for energy. But glucose
can’t just float into your cells. It has to be helped into your cells by
insulin, a hormone produced in the beta cells of your pancreas. When your body
stopped making enough insulin (insulin deficiency) or your cells stopped responding
well to the insulin you did make (insulin resistance), the glucose in your
blood couldn’t get into your cells. As a result, your blood glucose levels went
up, and you were diagnosed with diabetes.
It used to be easier to decide which type of diabetes
a person had. Under 30? Must be type 1. Over 40? Type 2. Thin? Type 1.
Overweight? Type 2. But now, two-thirds of American adults are overweight or
obese, and so are many children and teens. So you can be overweight and develop
type 1, and you don’t have to be an adult anymore to be at risk for type 2.
Below are brief descriptions of four types of
diabetes. Click on each name to go to more detailed information about it.
Type 1 Diabetes
Most cases of type 1 diabetes are diagnosed in
children, teens, and young adults. People with type 1 diabetes make little to
no insulin and must use injected insulin. Fewer than 10 percent of all people
with diabetes have type 1.
Type 2 Diabetes
Type 2 is the most common form of diabetes. In type 2
diabetes, the body needs more insulin than normal, but it can’t make enough.
People with type 2 diabetes use meal planning, physical activity, pills,
insulin, and other injectable medications to control their blood glucose
levels.
Latent Autoimmune Diabetes of Adults (LADA)
LADA progresses more slowly than typical type 1. It
is sometimes called “type 1.5 diabetes.”
Gestational Diabetes
Gestational diabetes is diabetes that is diagnosed
during pregnancy.
Type 1 Diabetes
How It Started
Years before you were diagnosed, your immune system
began to attack the beta cells of your pancreas. Normally, the immune system
attacks only foreign invaders, such as bacteria and viruses. When the immune
system attacks the body’s own cells, it’s called an autoimmune process.
Some of your beta cells were destroyed by this autoimmune attack, but you had plenty of others left to do the work, so your glucose levels stayed within the normal range. The autoimmune attacked continued, however, and after many more of your beta cells were destroyed, your body started having a little trouble dealing with glucose. Your blood glucose levels went too high after meals, but they weren’t high enough long enough to cause symptoms.
As more beta cells were lost, your blood glucose
levels became too high for much of the day. You started to show the classic
symptoms of type 1 diabetes.
Symptoms of Type 1 Diabetes
Thirsty, drinking a lot
Urinating
more than usual
Losing
weight without trying
Feeling
hungry and tired
If you were lucky, you were diagnosed and started on
insulin before you got very sick. With insulin therapy, you try to mimic
natural insulin levels. You need a low level of insulin all day, plus extra
insulin to cover meals. This requires three or four shots of insulin a day or
the use of an insulin pump.
The Honeymoon
After you started using insulin, did your requirement
for insulin drop a lot? Were you able to control your diabetes on low doses of
insulin? This is called a honeymoon. Here’s how it can happen:
You were on the road to type 1 diabetes, but not
there yet. Your remaining beta cells were able to squeeze out enough insulin.
Then perhaps your body was put under stress. It could have been an illness,
such as the flu, or it could have been an emotional stress, such as a death in
the family or a natural disaster.
When you’re under stress, your body wants to have
extra glucose available, so your liver releases stored glucose. This worked
fine before you were developing diabetes-your beta cells simply put out more
insulin so that your body could use the extra glucose.
But by this time, most of your beta cells had been
destroyed. Your few remaining beta cells could handle a normal amount of
glucose, but they couldn’t put out enough insulin to cover this extra glucose,
so your blood glucose levels went up.
High levels of glucose smother beta cells. This is
called glucose toxicity. Your remaining beta cells were still alive, but they
stopped working. Your blood glucose levels jumped even higher, and you were
diagnosed with diabetes.
When you started to take insulin, your blood glucose
levels came down. Freed of the excess glucose, your remaining beta cells
started to produce insulin again. You needed less injected insulin, and your
blood glucose levels were easy to control.
This honeymoon can last weeks or months. But the
destruction of your beta cells by your immune system will continue. Eventually,
all your beta cells will be destroyed. A year after diagnosis, most people with
type 1 diabetes are making little to no insulin of their own. The time between
diagnosis and when all the beta cells are gone tends to be shorter in children
and longer in adults.
Why Me?
Certain genes put a person at higher risk of
developing type 1 diabetes. But genes aren’t the whole story; environment plays
a role.
It seems that a person has a genetic susceptibility
and then encounters a trigger at just the wrong time. Many possible triggers
for type 1 diabetes have been proposed, including certain viruses.
What can you do to protect the beta cells you have
left?
Researchers are looking for treatments that will stop
the immune system’s attack on the beta cells without too many side effects.
This would not be a cure for diabetes. But if your immune system’s attack could
be slowed or stopped, you could keep making some insulin. This would make your
blood glucose levels easier to control.
Early-intervention studies accept participants who
have been recently diagnosed. The timing depends on the study: One study may
accept only people who have had diabetes for less than one week, while another
may take people up to three months after diagnosis.
