Diabetes

Diabetes mellitus is a chronic metabolic disorder characterized by elevated blood glucose levels (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both. There are several types of diabetes, with Type 1, Type 2, and gestational diabetes being the most common. Type 1 diabetes is an autoimmune condition where the pancreas produces little or no insulin, typically appearing in childhood or adolescence. Type 2 diabetes, the most prevalent form, involves insulin resistance and relative insulin deficiency, often developing in adulthood and associated with lifestyle factors. Gestational diabetes occurs during pregnancy and usually resolves after delivery, though it increases future diabetes risk. Regardless of type, uncontrolled diabetes can lead to serious complications affecting the heart, blood vessels, nerves, eyes, and kidneys. With proper management through medication, lifestyle modifications, and regular monitoring, people with diabetes can lead long, active lives while minimizing complication risks.

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What Causes It?

Type 1 Diabetes - Autoimmune destruction of insulin-producing beta cells in the pancreas

Genetic susceptibility - Family history increases risk, particularly for Type 1 and Type 2 diabetes

Environmental triggers - Viral infections may trigger Type 1 diabetes in genetically susceptible individuals

Obesity - Strong risk factor for Type 2 diabetes, especially abdominal obesity

Physical inactivity - Contributes to insulin resistance and Type 2 diabetes risk

Poor diet - High in refined carbohydrates, sugars, and processed foods increases risk

Insulin resistance - Cells don't respond properly to insulin, leading to Type 2 diabetes

Age - Risk of Type 2 diabetes increases with age, especially after 45

Pregnancy - Hormonal changes can lead to gestational diabetes

Previous gestational diabetes - Increases future Type 2 diabetes risk

Polycystic ovary syndrome - Associated with insulin resistance and increased diabetes risk

Certain medications - Corticosteroids, antipsychotics, and some HIV medications can raise blood glucose

Ethnicity - Higher risk in South Asian, Black, Hispanic, and Indigenous populations

Stress and stress hormones - Can temporarily raise blood glucose levels

Sleep disorders - Poor sleep quality and sleep apnea linked to insulin resistance

Signs & Symptoms

Increased thirst (polydipsia) - Often one of the first noticeable symptoms

Frequent urination (polyuria) - Including nighttime urination (nocturia)

Increased hunger (polyphagia) - Particularly after eating

Unexplained weight loss - Despite normal or increased food intake (more common in Type 1)

Fatigue - Persistent tiredness and weakness

Blurred vision - Due to changing fluid levels affecting the eye's lens

Slow-healing sores or frequent infections - Particularly skin, gum, or bladder infections

Tingling or numbness in hands or feet - Early sign of nerve damage (neuropathy)

Dark patches of skin - Usually in the armpits and neck (acanthosis nigricans), associated with insulin resistance

Irritability - Mood changes due to blood sugar fluctuations

Fruity-smelling breath - Sign of ketoacidosis, a dangerous condition more common in Type 1 diabetes

Type 2 diabetes may develop gradually with subtle or no symptoms initially

Type 1 diabetes typically has a more rapid onset of symptoms

Gestational diabetes often has no noticeable symptoms and is detected through screening

Symptoms may appear at different blood glucose thresholds for different individuals

How We Diagnose

Our specialists use advanced diagnostic methods to accurately identify and assess your condition

Fasting Plasma Glucose (FPG) Test

Measures blood glucose after fasting for at least 8 hours. A level of 126 mg/dL (7.0 mmol/L) or higher on two separate tests indicates diabetes. Levels between 100-125 mg/dL (5.6-6.9 mmol/L) indicate prediabetes. This test is commonly used due to its convenience and cost-effectiveness but may miss some cases of diabetes that only show elevated glucose levels after eating.

Oral Glucose Tolerance Test (OGTT)

Measures how the body processes glucose over time. After fasting overnight, blood glucose is measured, then the patient drinks a sweet solution containing 75g of glucose. Blood glucose is measured again after 2 hours. A 2-hour reading of 200 mg/dL (11.1 mmol/L) or higher indicates diabetes. Levels between 140-199 mg/dL (7.8-11.0 mmol/L) indicate prediabetes or impaired glucose tolerance. This test is particularly useful for diagnosing gestational diabetes and can detect diabetes in people with normal fasting glucose levels.

Hemoglobin A1C Test

Measures average blood glucose over the past 2-3 months by showing the percentage of hemoglobin proteins in the blood that are glycated (have glucose attached). An A1C level of 6.5% or higher on two separate tests indicates diabetes. Levels between 5.7-6.4% indicate prediabetes. This test doesn't require fasting and provides insight into long-term glucose control. However, it may be less accurate in certain conditions affecting red blood cells, such as anemia, recent blood loss, or certain hemoglobin variants.

Random Plasma Glucose Test

Measures blood glucose regardless of when the person last ate. A level of 200 mg/dL (11.1 mmol/L) or higher, along with symptoms of diabetes, indicates diabetes. This test may be used when diabetes is strongly suspected, but it usually requires confirmation with one of the other tests.

Autoantibody Testing

Blood tests that detect autoantibodies against insulin, glutamic acid decarboxylase (GAD), or islet cells. Presence of these antibodies helps confirm Type 1 diabetes or Latent Autoimmune Diabetes in Adults (LADA). Common antibodies tested include GAD antibodies, islet cell antibodies (ICA), insulin autoantibodies (IAA), and zinc transporter 8 antibodies (ZnT8). This testing is particularly important when the type of diabetes is unclear or when Type 1 diabetes is suspected in adults.

C-peptide Test

Measures the level of C-peptide, a byproduct of insulin production. Low levels indicate little insulin production, suggesting Type 1 diabetes. Normal or high levels with high blood glucose suggest insulin resistance, indicating Type 2 diabetes. This test helps distinguish between different types of diabetes and assess remaining insulin production in established diabetes.

Treatment Options

Personalized treatment plans tailored to your specific needs and condition

Insulin Therapy

Essential for all people with Type 1 diabetes and many with advanced Type 2 diabetes. Insulin cannot be taken orally as digestive enzymes would destroy it, so it's administered by injection or continuous infusion pump. Multiple types exist with varying onset and duration: rapid-acting (works within 15 minutes, lasts 2-4 hours), short-acting (works within 30 minutes, lasts 3-6 hours), intermediate-acting (works within 2-4 hours, lasts 12-18 hours), and long-acting (works gradually, lasts up to 24 hours). Treatment regimens include basal-bolus approach (long-acting insulin plus mealtime doses), multiple daily injections, or insulin pump therapy, which delivers continuous subcutaneous insulin infusion. Dosing is individualized based on blood glucose levels, carbohydrate intake, physical activity, and other factors.

Oral and Non-Insulin Injectable Medications

Used primarily in Type 2 diabetes to improve insulin sensitivity, increase insulin production, slow carbohydrate absorption, or reduce glucose production. Major classes include: Metformin (first-line therapy that reduces liver glucose production and improves insulin sensitivity); Sulfonylureas and Meglitinides (stimulate insulin release from the pancreas); DPP-4 inhibitors (increase incretin hormones that stimulate insulin release); SGLT2 inhibitors (promote glucose excretion through urine); Thiazolidinediones (improve insulin sensitivity); GLP-1 receptor agonists (injectable medications that increase insulin secretion, slow gastric emptying, and reduce appetite); Alpha-glucosidase inhibitors (slow carbohydrate digestion and absorption). Medication selection considers efficacy, side effects, cost, weight effects, comorbidities, and patient preferences.

Blood Glucose Monitoring

Regular monitoring helps guide treatment decisions and prevent complications. Self-monitoring of blood glucose (SMBG) involves pricking the finger to obtain a blood sample for testing with a glucose meter. Continuous glucose monitoring (CGM) systems use a small sensor inserted under the skin to measure glucose levels every few minutes, with results displayed on a receiver or smartphone. CGM provides more comprehensive data, including trends and alerts for high or low glucose levels. Time in range (percentage of time spent within target glucose range) has emerged as an important metric alongside A1C. Monitoring frequency depends on diabetes type, medication regimen, and individual needs—ranging from several times daily to periodic checks.

Nutrition Therapy

Individualized nutritional planning is fundamental to diabetes management. Rather than a one-size-fits-all "diabetic diet," current approaches emphasize personalized meal planning based on preferences, cultural background, and metabolic goals. Carbohydrate counting or awareness helps match insulin doses to carbohydrate intake for those on insulin therapy. The Mediterranean, DASH, and plant-based diets show benefits for diabetes management. Consistent meal timing helps maintain stable blood glucose, especially for those on certain medications. Portion control and weight management are emphasized for Type 2 diabetes. Medical nutrition therapy provided by registered dietitians helps develop sustainable eating patterns that improve glucose control, lipid profiles, and blood pressure while addressing individual nutrition needs and preferences.

Physical Activity

Regular exercise improves insulin sensitivity, helps maintain healthy weight, reduces cardiovascular risk, and improves overall wellbeing. Both aerobic exercise (walking, swimming, cycling) and resistance training (weight lifting, resistance bands) provide benefits. Adults with diabetes should aim for at least 150 minutes of moderate-intensity activity weekly, spread over at least 3 days, with no more than 2 consecutive days without activity. Resistance training is recommended 2-3 times weekly. Those taking insulin or insulin secretagogues may need to adjust medication or carbohydrate intake to prevent hypoglycemia during or after exercise. Starting slowly and progressing gradually is important, especially for previously sedentary individuals. All people with diabetes should receive clearance from healthcare providers before beginning vigorous exercise programs, particularly those with complications like retinopathy or neuropathy.

Diabetes Self-Management Education and Support

Structured education programs that provide knowledge and skills needed for diabetes self-care, typically delivered by certified diabetes educators. Key components include medication management, monitoring, interpreting and using glucose data, meal planning, physical activity, preventing and managing complications, and problem-solving strategies. Psychosocial support addresses the emotional aspects of living with diabetes, including diabetes distress, depression, anxiety, and eating disorders, which are more common in people with diabetes. Peer support through group education or online communities can provide valuable practical and emotional support. Education should be ongoing, with particular focus at diagnosis, annually, when complications develop, or during care transitions.

Home Remedies

Meal Planning and Preparation

Prepare balanced meals following the plate method: fill half your plate with non-starchy vegetables, one quarter with lean protein, and one quarter with carbohydrates (preferably whole grains). Pre-portion snacks to prevent overeating. Experiment with herbs and spices instead of salt for flavoring. Keep a food journal to identify how different foods affect your blood glucose. Prepare meals at home when possible to control ingredients and portion sizes. Consider batch cooking on weekends to have healthy options available during busy weekdays. Read food labels carefully, paying attention to total carbohydrates rather than just sugar content. Stay hydrated with water rather than sugary beverages.

Building Physical Activity into Daily Life

Incorporate movement throughout the day, not just during planned exercise sessions. Take short walking breaks every 30 minutes if you have a sedentary job. Use stairs instead of elevators when possible. Park farther from entrances to add short walks. Consider active hobbies like gardening, dancing, or recreational sports. Use smartphone apps or fitness trackers to monitor activity and set achievable goals. Find an exercise buddy for motivation and accountability. Remember that housework, yard work, and playing with children all count as physical activity. If you're just starting, begin with 5-10 minutes of activity and gradually increase duration and intensity.

Glucose Monitoring Techniques

Establish a consistent routine for checking blood glucose, such as before meals and at bedtime. Keep a logbook or use a smartphone app to track readings, noting factors that might affect levels (food, activity, stress, illness). Learn how to recognize patterns in your data rather than focusing on individual readings. If using a traditional meter, rotate testing sites and ensure hands are clean before testing. For those using continuous glucose monitoring (CGM), understand how to interpret trend arrows and set appropriate alerts. Learn how different factors affect your glucose: food types and quantities, timing of meals, physical activity, stress, illness, and medication timing. Share your data with healthcare providers between visits if you notice concerning patterns.

Foot Care Practices

Inspect feet daily for cuts, blisters, redness, swelling, or nail problems, using a mirror or asking for help to check the bottoms of feet. Wash feet daily in lukewarm (not hot) water, dry thoroughly, especially between toes. Apply moisturizer to the tops and bottoms of feet but not between toes. Trim toenails straight across and file edges with an emery board. Wear clean, dry socks made of fibers that wick moisture, changed daily. Always wear shoes that fit well and check inside shoes before wearing them. Protect feet from temperature extremes, including testing bath water before stepping in. Keep blood flowing to feet by putting them up when sitting, wiggling toes throughout the day, and engaging in regular physical activity.

Stress Management

Practice deep breathing exercises when feeling stressed: inhale slowly through the nose for a count of four, hold for a count of seven, then exhale completely through the mouth for a count of eight. Try progressive muscle relaxation by tensing and then releasing each muscle group. Explore mindfulness meditation, which focuses attention on the present moment without judgment. Maintain social connections, which are vital for emotional wellbeing. Consider keeping a gratitude journal, noting three things you're thankful for each day. Engage in activities you enjoy that provide a sense of accomplishment or pleasure. Break large tasks into smaller, manageable steps to prevent feeling overwhelmed. Recognize the relationship between stress and blood glucose levels, checking more frequently during stressful periods and adjusting treatment if needed.

Prevention Tips

Schedule regular healthcare visits, including quarterly or biannual appointments with your diabetes care provider and annual comprehensive examinations

Maintain glycemic control with A1C levels individualized to your specific situation, typically aiming for less than 7% for many adults without significant hypoglycemia risk

Monitor and manage blood pressure, with a general target of less than 140/90 mmHg, or lower for those at high risk of cardiovascular disease

Check and control cholesterol levels, typically with statin therapy for most adults with diabetes who have cardiovascular risk factors

Undergo annual comprehensive eye examinations with dilation to detect retinopathy early, or more frequently if abnormalities are present

Have annual comprehensive foot examinations, including visual inspection, monofilament testing for sensation, and pulse assessment

Monitor kidney function with annual urine albumin-to-creatinine ratio testing and estimated glomerular filtration rate (eGFR) measurement

Receive recommended vaccinations, including annual influenza vaccine, pneumococcal vaccines, hepatitis B series, and COVID-19 vaccines

Undergo regular dental examinations every six months due to increased risk of gum disease

Get screened for depression and diabetes distress at least annually and when complications develop or treatment changes

Consider daily aspirin therapy if recommended by your healthcare provider for cardiovascular disease prevention

Quit smoking and avoid all tobacco products; seek professional help for cessation if needed

Limit alcohol consumption to moderate levels (no more than one drink daily for women, two for men) and only when blood glucose is well-controlled

Wear medical identification (bracelet, necklace, or card) indicating you have diabetes

Develop a sick-day management plan with your healthcare provider to prevent serious complications during illness

Surgical Solutions

Advanced surgical procedures performed by our expert specialists

Metabolic/Bariatric Surgery

Surgical procedures that alter the digestive system, primarily used for weight loss but with significant benefits for Type 2 diabetes. Common procedures include Roux-en-Y gastric bypass (reduces stomach size and bypasses part of small intestine), sleeve gastrectomy (removes portion of stomach), and adjustable gastric banding (places an inflatable band around upper stomach). These surgeries often lead to diabetes remission or significant improvement, particularly with Roux-en-Y gastric bypass, which shows remission rates of 60-80% in the first year. Benefits occur both through weight loss and weight-independent mechanisms involving gut hormones and bile acid metabolism. Currently recommended for people with Type 2 diabetes and BMI ≥35 kg/m², with consideration for those with BMI 30-34.9 kg/m² when diabetes is inadequately controlled by lifestyle and medications.

Pancreas Transplantation

Surgical placement of a healthy donor pancreas into a person with diabetes, most commonly performed in conjunction with kidney transplantation in Type 1 diabetes patients with end-stage kidney disease. A successful pancreas transplant can eliminate the need for insulin therapy and normalize blood glucose levels. However, it requires major surgery and lifelong immunosuppressive medications to prevent organ rejection, which carry significant risks. The procedure may be done as simultaneous pancreas-kidney transplantation (SPK), pancreas after kidney transplantation (PAK), or pancreas transplantation alone (PTA). Candidates must undergo extensive evaluation and meet specific criteria. This option is generally reserved for those with Type 1 diabetes with life-threatening complications or extreme difficulty managing blood glucose levels.

Islet Cell Transplantation

A minimally invasive procedure where insulin-producing islet cells from a donor pancreas are isolated and infused into the portal vein of the liver, where they take up residence and begin producing insulin. This procedure aims to restore insulin production without major surgery. Recipients require immunosuppressive medications to prevent rejection of the transplanted cells. Currently considered experimental and primarily available through clinical trials. Most recipients achieve improved blood glucose control and reduced hypoglycemia, though many still require some insulin. The procedure is being studied as a treatment for Type 1 diabetes patients with recurrent severe hypoglycemia or extreme glucose variability despite optimal management. Challenges include limited donor supply and gradual decline in islet function over time.

Surgery for Diabetes Complications

Various surgical procedures may be necessary to address complications of long-standing diabetes. These include vitrectomy or laser photocoagulation for advanced diabetic retinopathy; coronary artery bypass grafting or angioplasty for coronary artery disease; peripheral vascular procedures for severe peripheral arterial disease; amputation for non-healing foot ulcers or gangrene; and carpal tunnel release for diabetic neuropathy affecting the wrists. Early detection and management of diabetes can significantly reduce the need for these interventions. For those with complications, comprehensive care coordinated between diabetes specialists and surgical teams is essential for optimal outcomes.

Implantable Diabetes Devices

Surgically implanted devices that assist with diabetes management. These include fully implantable insulin pumps (currently experimental), which deliver insulin from a reservoir placed under the skin; implantable continuous glucose monitoring sensors with extended wear time; and vascular access devices for patients requiring frequent intravenous treatments. Research continues on closed-loop artificial pancreas systems with implantable components that would automatically adjust insulin delivery based on glucose readings without user intervention. While not traditional surgery, the placement of these devices often involves minor surgical procedures and represents an important intersection between technological and surgical approaches to diabetes management.

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