How to Identify Diabetes

Diabetes is a metabolic disorder that interferes with the body's ability to use and produce insulin, which also regulates how the body utilizes blood sugar to create energy. When cells become resistant to insulin or the body is unable to produce enough of it, blood sugar levels rise, leading to a range of immediate and long-term symptoms of diabetes. There are four types of diabetes: prediabetes, type 1 diabetes, type 2 diabetes, and gestational diabetes. Each type shares some common symptoms but also has distinct ones that differentiate them.

Assess the risk for gestational diabetes. Gestational diabetes occurs in pregnant women. If you're considered high-risk, you may be tested during your first prenatal visit and again after the second trimester. Women at lower risk are typically tested in the second trimester, from weeks 24 to 28. Those who experience gestational diabetes are at a higher risk of developing type 2 diabetes within 10 years after childbirth. Risk factors include:

• Pregnancy at the age of 25 or older
• Personal or family history of diabetes or prediabetes
• Being overweight during pregnancy (BMI of 30 or higher)
• Women of African, Hispanic, Native American, Asian, or Pacific Islander descent
• Having a third or subsequent pregnancy
• Excessive uterine growth during pregnancy

Be aware of the risk factors for prediabetes. Prediabetes is a metabolic condition where blood sugar levels are higher than normal (70-99), but still below the level where medication is required to control blood sugar. The risk factors for prediabetes include:

• Age 45 or older
• Overweight
• Family history of type 2 diabetes
• Inactive lifestyle
• High blood pressure
• History of gestational diabetes
• Having given birth to a baby weighing 4 kg or more

Evaluate the risk of type 2 diabetes. This type is sometimes referred to as “comprehensive” diabetes. In this condition, the body’s cells become resistant to the effects of leptin and insulin. This leads to increased blood sugar levels, causing symptoms and long-term effects. The risk factors for type 2 diabetes are similar to those for prediabetes, and include:

• Over 45 years old
• Overweight
• Lack of physical activity
• High blood pressure
• History of gestational diabetes
• Having given birth to a baby weighing over 4 kg
• Family history of diabetes
• Chronic stress
• Being of African, Hispanic, Native American, Asian, or Pacific Islander descent

Check the risk factors for type 1 diabetes. Experts believe this condition is caused by a combination of genetic and environmental factors.

• White individuals are at a higher risk of developing type 1 diabetes.
• Cold weather and viruses can trigger the development of type 1 diabetes in those at high risk.
• Childhood stress.
• Children who were breastfed and introduced to solid foods later are less likely to develop type 1 diabetes, regardless of genetic risk factors.
• If you have a sibling with type 1 diabetes, you have a 50% chance of developing the condition yourself.

Get tested for gestational diabetes during pregnancy. Women with gestational diabetes often do not exhibit symptoms. Therefore, it is important to request testing if you are at risk of gestational diabetes. This condition is especially dangerous as it affects both you and your baby. Early diagnosis is crucial due to its long-term impact on your child.

• Some women experience increased thirst and frequent urination, although these are also normal signs of pregnancy.
• Some women report feeling discomfort or unease after consuming large amounts of starches or sugars.

Be cautious of prediabetes symptoms. Similar to gestational diabetes, prediabetes often shows minimal symptoms. Diabetes symptoms are typically caused by very high blood pressure, which is not present in prediabetes. If you have risk factors for prediabetes, regular testing is essential, even for small symptoms. Prediabetes can develop into full-blown diabetes if not addressed.

• You might have prediabetes if you suffer from "acanthosis nigricans"—dark, thickened patches of skin typically found around the armpits, neck, elbows, knees, and knuckles.
• You may experience discomfort after consuming starchy or sugary meals.
• Your doctor may recommend a prediabetes test if you have high cholesterol, hypertension, hormonal imbalances like metabolic syndrome, or if you are overweight.

Recognizing Type 2 Diabetes Symptoms. Whether you have risk factors or not, you can still develop Type 2 diabetes. Stay alert to your health and monitor signs that suggest rising blood sugar levels:

• Unexplained weight loss
• Blurred vision or changes in eyesight
• Increased thirst due to high blood sugar
• Frequent urination
• Fatigue and drowsiness, even after a full night's sleep
• Tingling or numbness in the hands or feet
• Frequent infections or recurring urinary tract, skin, or mouth infections
• Trembling or hunger mid-morning or afternoon
• Wounds or cuts that take longer to heal.
• Dry, itchy skin or unusual lumps or blisters.
• Increased hunger than usual.

Suspecting Type 1 Diabetes with Sudden Symptoms. While most people develop Type 1 diabetes in childhood or adolescence, it can also develop in adulthood. Symptoms of Type 1 diabetes may appear suddenly or go unnoticed for a while, and may include:

• Excessive thirst
• Frequent urination
• Vaginal yeast infections in women
• Restlessness
• Blurred vision
• Unexplained weight loss
• Bedwetting in children
• Intense hunger
• Fatigue and weakness

Seek Medical Care When Necessary. Diabetes symptoms are often overlooked, allowing the condition to progress to dangerous levels. Type 2 diabetes symptoms develop gradually over time, but in Type 1 diabetes, the body can suddenly stop producing insulin. If not treated quickly, severe symptoms may emerge that can be life-threatening. These symptoms include:

• Rapid, deep breathing
• Flushed face, dry skin, and mouth
• Sweet-smelling breath, like fruit
• Nausea and vomiting
• Stomach pain
• Confusion or lethargy

Consult a doctor as soon as symptoms appear. The doctor will need to perform several tests to determine if you have diabetes. If diagnosed with diabetes or prediabetes, it is essential to follow a regular treatment plan under the guidance of a healthcare professional.

Blood Sugar Test. The blood sugar test does exactly what its name suggests: it measures the glucose level in your blood. This test is used to determine whether you have diabetes or are at risk of developing it. The test is done in one of three scenarios:

• A fasting blood sugar test, which requires you to refrain from eating for at least 8 hours. In emergencies, a random blood sugar test may be conducted, regardless of whether you’ve eaten.
• A two-hour post-meal blood sugar test, done after you consume a specific amount of carbohydrates to check how your body processes sugar. This test is usually conducted in a hospital, where they can measure the carbohydrate intake prior to the test.
• An oral glucose tolerance test, where you drink a liquid high in glucose. Blood and urine tests are taken every 30-60 minutes to assess how your body handles the additional sugar. This test is not done if the doctor suspects Type 1 diabetes.

A1C Test. This blood test, also called the glycated hemoglobin test, measures the amount of glucose attached to hemoglobin molecules in your blood. It provides your doctor with an average of your blood sugar levels over the past 30-60 days.

Ketone Test if Necessary. Ketones appear in the blood when a lack of insulin forces the body to break down fat for energy. Ketones are excreted in the urine, commonly found in Type 1 diabetes patients. Your doctor may suggest testing blood or urine for ketones if:

• Your blood sugar exceeds 240mg/dL.
• You have certain illnesses like pneumonia, stroke, or heart attack.
• You experience nausea or vomiting.
• You are pregnant.

Routine Testing Recommendations. If you have diabetes or are at high risk for developing it, regular monitoring of your health and blood sugar is crucial. High blood sugar can damage the tiny blood vessels in various organs of your body. These damages can lead to widespread health issues. For comprehensive health monitoring, you should:

• Have an annual eye exam
• Assess for diabetic nerve damage in the feet
• Monitor your blood pressure regularly (at least once a year)
• Get an annual kidney test
• Undergo dental cleanings every 6 months
• Have regular cholesterol tests
• Visit your primary healthcare provider or endocrinologist for regular check-ups

Choosing the right lifestyle for prediabetes and Type 2 diabetes. These conditions often develop more due to lifestyle factors than genetic predisposition. By making changes to your lifestyle, you can lower blood sugar levels or prevent the progression of the disease.

Reduce starch intake. When the body converts starch into sugar, it requires more insulin. Cutting back on grains, pasta, sweets, soda, and other foods with high amounts of simple starches will help, as the body processes these foods too quickly, leading to a spike in blood sugar. Consult with your doctor or a nutritionist about incorporating complex starches with higher fiber content and a low glycemic index into your diet. Examples include:

• Beans and legumes
• Non-starchy vegetables (most vegetables except for those like yellow beets, plantains, potatoes, squash, peas, corn)
• Most fruits (except for dried fruits, bananas, and grapes)
• Whole grains such as steel-cut oats, bran, whole wheat pasta, barley, bulgur, brown rice, quinoa

Increase intake of protein and healthy fats. Once considered a cause of heart disease, healthy fats found in avocados, coconut oil, grass-fed beef, and free-range chicken are now viewed as valuable energy sources. These fats can help stabilize blood sugar and reduce cravings.

• Omega-3 fatty acids found in cold-water fish such as tuna or salmon may reduce the risk of developing Type 2 diabetes. Aim for 1-2 servings of fish per week.

Maintain a healthy weight. Insulin resistance increases in proportion to waist size. It is easier to stabilize blood sugar levels when maintaining a healthy weight. Combining a balanced diet and regular exercise will help you keep your weight in check. Spend 30 minutes a day on physical activity to help your body utilize glucose without insulin. This also aids in maintaining a healthy weight and improving sleep quality.

Quit smoking. If you smoke, stop immediately. Smokers are at a 30-40% higher risk of developing Type 2 diabetes compared to non-smokers, and the risk increases the more you smoke. Smoking also leads to many dangerous complications for those already diagnosed with diabetes.

Don't rely solely on medication. If you have Type 1, Type 2 diabetes, or gestational diabetes, your doctor may prescribe medication alongside lifestyle changes. However, you can't solely depend on medication to control the disease. Medication is only an aid to the main changes that come from adjusting your lifestyle.

Take hypoglycemic medication if you have Type 2 diabetes or gestational diabetes. These medications come in oral form and work to lower blood sugar levels throughout the day. Some common medications include Metformin (biguanides), sulfonylureas, Meglitinides, alpha-glucosidase inhibitors, and combination oral pills.

Inject insulin if you have Type 1 diabetes. This is the only effective way to treat Type 1 diabetes, though it can also be used for Type 2 and gestational diabetes. There are four types of insulin used for this treatment. Your doctor will determine which one is most effective for controlling your blood sugar. You may use one type or combine multiple types at different times during the day. Your doctor may also suggest using an insulin pump to maintain insulin levels 24 hours a day.

• Rapid-acting insulin is used before meals, usually combined with long-acting insulin.
• Short-acting insulin is used 30 minutes before meals, typically combined with long-acting insulin.
• Intermediate-acting insulin is taken twice a day and helps reduce blood sugar after the effects of rapid and short-acting insulin wear off.
• Long-acting insulin is used when rapid and short-acting insulin effects have worn off.

• Be aware of risk factors and seek medical advice if you experience symptoms of diabetes.
• Particularly take note when you are hot or cold. Both conditions can increase blood sugar levels and also affect medications and testing equipment.

• Do not self-treat diabetes at home. Long-term complications of diabetes can include kidney disease, blindness, amputations, diabetic neuropathy, and death. You can reduce medication use by changing your lifestyle and following your doctor's guidance.