Diabetes - Signs & Symptoms, Diagnosis & Management

Infections & Diseases

Table of Contents: Definition of Diabetes / Types of Diabetes and its Causes (Prediabetes, Type 1 Diabetes, Type 2 Diabetes, Gestational Diabetes, Other Types of Diabetes) / Signs and Symptoms of Diabetes (Increased thirst (polydipsia) and frequent urination (polyuria), Extreme hunger (polyphagia), Weight loss, Blurred vision, Fatigue, Diabetic emergencies, Slow-healing sores or frequent infections, Nerve damage (neuropathy), Red, swollen, tender gums, Symptoms of Type 1 Diabetes, Symptoms of Type 2 Diabetes, Symptoms of Gestational Diabetes) / Diagnosis of Diabetes (What is the proper blood sugar level?) / Complications of Diabetes / Prevention, Treatment and Management of Diabetes / Alternative Medicine for Diabetes (Glucose Control, Metformin, Blood Pressure Lowering, Lifestyle, Weight Loss, Nutrition and Diet for Diabetes, Herbal Medicine, Support)

Diabetes mellitus, commonly known as diabetes is a group of metabolic disorders characterized by a high blood sugar (glucose) level over a prolonged period of time, because the body does not produce enough insulin.

Insulin, a hormone released from the pancreas, controls the amount of sugar in the blood. When a person eats or drinks, food is broken down into materials, including sugar, that the body needs to function normally. Sugar is absorbed into the bloodstream and stimulates the pancreas to produce insulin. Insulin allows sugar to move from the blood into the cells, once inside the cells, sugar is converted to energy. Which is either used immediately or stored until it is used.

If the body does not produce enough insulin to move the sugar into the cells, the resulting high levels of sugar in the blood and the inadequate amount of sugar in the cells together produce the symptoms and complications of diabetes.

Symptoms often include frequent urination, increased thirst, and increased appetite. Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death. Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, damage to the nerves or damage to the eyes and cognitive impairment. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body not responding properly to the insulin produced.

There are now over 21 million people with diabetes in United States alone. As of 2019, an estimated 463 million people had diabetes worldwide (8.8% of the adult population), with type 2 diabetes making up about 90% of the cases. Rates are similar in women and men. Trends suggest that rates will continue to rise. Diabetes at least doubles a person's risk of early death. In 2019, diabetes resulted in approximately 4.2 million deaths. It is the 7th leading cause of death globally. Average medical expenditures among people with diabetes are about 2.3 times higher.

Diabetes mellitus is classified into four broad categories: type 1 diabetes, type 2 diabetes, gestational diabetes, and "other specific types". The "other specific types" are a collection of a few dozen individual causes. Diabetes is a more variable disease than once thought and people may have combinations of forms. The term "diabetes", without qualification, refers to diabetes mellitus.

Prediabetes:

Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. Prediabetes puts you at increased risk of developing type 2 diabetes, heart disease, and stroke.

You can have prediabetes for years but have no clear symptoms, so it often goes undetected until serious health problems such as type 2 diabetes show up. It’s important to talk to your doctor about getting your blood sugar tested if you have any of the risk factors for prediabetes, which include: Being overweight, being 45 years or older, having a parent, brother, or sister with type 2 diabetes, Being physically active less than 3 times a week, ever having gestational diabetes (diabetes during pregnancy) or giving birth to a baby who weighed more than 9 pounds or having polycystic ovary syndrome.

Race and ethnicity are also a factor: African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, and some Asian Americans are at higher risk.

You can get a simple blood sugar test to find out if you have prediabetes. Ask your doctor if you should be tested.

Type 1 Diabetes:

Is an autoimmune disease that occurs when T cells attack and decimate the beta cells in the pancreas that are needed to produce insulin. The pancreas makes too little insulin or no insulin. Without the capacity to make adequate amounts of insulin, the body is not able to metabolize blood sugar (glucose), and toxic acids (ketoacidosis) build up in the body. There is a genetic predisposition to type 1 diabetes.

The disease tends to occur in childhood, adolescence or early adulthood, before age 30, but it may have its clinical onset at any age. The symptoms and signs of type 1 diabetes characteristically appear abruptly, although the damage to the beta cells may begin much earlier and progress slowly and silently.

This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The cause of this autoimmune response is unknown.

Type 1 diabetes is partly inherited, with multiple genes, including certain HLA genotypes, known to influence the risk of diabetes. In genetically susceptible people, the onset of diabetes can be triggered by one or more environmental factors, such as a viral infection or diet. Several viruses have been implicated, but to date there is no stringent evidence to support this hypothesis in humans. Among dietary factors, data suggest that gliadin (a protein present in gluten) may play a role in the development of type 1 diabetes, but the mechanism is not fully understood.

It can occur at any age, and a significant proportion is diagnosed during adulthood. Latent autoimmune diabetes of adults (LADA) is the diagnostic term applied when type 1 diabetes develops in adults; it has a slower onset than the same condition in children. Given this difference, some use the unofficial term "type 1.5 diabetes" for this condition. Adults with LADA are frequently initially misdiagnosed as having type 2 diabetes, based on age rather than cause.

Type 2 Diabetes:

Is the type in which the beta cells of the pancreas produce insulin but the body is unable to use it effectively because the cells of the body are resistant to the action of insulin. Although this type of diabetes may not carry the same risk of death from ketoacidosis, it otherwise involves many of the same risks of complications as does type 1 diabetes (in which there is a lack of insulin).

This form was previously referred to as "non-insulin dependent diabetes" (NIDDM) or "adult-onset diabetes". The most common cause is a combination of excessive body weight and insufficient exercise.

Type 2 diabetes is the most common type of diabetes mellitus. Many people with type 2 diabetes have evidence of pre-diabetes (impaired fasting glucose and/or impaired glucose tolerance) before meeting the criteria for type 2 diabetes. The progression of pre-diabetes to overt type 2 diabetes can be slowed or reversed by lifestyle changes or medications that improve insulin sensitivity or reduce the liver's glucose production.

Type 2 diabetes is primarily due to lifestyle factors and genetics. A number of lifestyle factors are known to be important to the development of type 2 diabetes, including obesity (defined by a body mass index of greater than 30), lack of physical activity, poor diet, stress, and urbanization. Excess body fat is associated with 30% of cases in people of Chinese and Japanese descent, 60–80% of cases in those of European and African descent, and 100% of Pima Indians and Pacific Islanders. Even those who are not obese may have a high waist–hip ratio.

Dietary factors such as sugar-sweetened drinks is associated with an increased risk. The type of fats in the diet is also important, with saturated fat and trans fats increasing the risk and polyunsaturated and monounsaturated fat decreasing the risk. Eating white rice excessively may increase the risk of diabetes, especially in Chinese and Japanese people. Lack of physical activity may increase the risk of diabetes in some people.

Gestational Diabetes:

Gestational diabetes resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2–10% of all pregnancies and may improve or disappear after delivery. It is recommended that all pregnant women get tested starting around 24–28 weeks gestation. It is most often diagnosed in the second or third trimester because of the increase in insulin-antagonist hormone levels that occurs at this time. However, after pregnancy approximately 5–10% of women with gestational diabetes are found to have another form of diabetes, most commonly type 2. Gestational diabetes is fully treatable, but requires careful medical supervision throughout the pregnancy. Management may include dietary changes, blood glucose monitoring, and in some cases, insulin may be required.

Though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital heart and central nervous system abnormalities, and skeletal muscle malformations. Increased levels of insulin in a fetus's blood may inhibit fetal surfactant production and cause infant respiratory distress syndrome. A high blood bilirubin level may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Labor induction may be indicated with decreased placental function. A caesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.

Other Types of Diabetes:

Maturity onset diabetes of the young (MODY) is a rare autosomal dominant inherited form of diabetes, due to one of several single-gene mutations causing defects in insulin production. It is significantly less common than the three main types, constituting 1-2% of all cases. The name of this disease refers to early hypotheses as to its nature. Being due to a defective gene, this disease varies in age at presentation and in severity according to the specific gene defect; thus there are at least 13 subtypes of MODY. People with MODY often can control it without using insulin.

Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes). This form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells, whereas others increase insulin resistance (especially glucocorticoids which can provoke "steroid diabetes").

The signs and symptoms of type 1 diabetes often appear after a flu-like illness and gradually intensify over the course of a few weeks. Typical symptom may include:

Increased thirst (polydipsia) and frequent urination (polyuria):

This diabetes symptom is common with type 1 diabetes, excess sugar (glucose) builds up in your bloodstream. A high level of blood glucose pulls water from your body's tissues, making you thirsty. As a result, a symptom of thirst or you drink more fluids and urinate more. The excess sugar in your bloodstream passes through your kidneys and leaves your body in your urine.

Extreme hunger (polyphagia):

Another diabetes symptom of diabetes is extreme hunger. Because of inability to produce insulin, the hormone necessary for glucose to enter cells and fuel their functions - leaves your muscles and organs energy depleted. A symptom of hunger makes you feel like eating more until your stomach is full, but the hunger persists because, without insulin, the glucose produced from dietary carbohydrates never reaches your body's energy-starved tissues.

Weight loss:

Despite eating a lot to relieve their constant hunger, another diabetes symptom of people with type 1 diabetes is rapid loss of weight. That's because the body's cells are deprived of glucose and energy, as glucose is lost into the urine. Without the energy glucose supplies, cells die at an increased rate before they can divide and replace themselves. Muscle tissues and fat stores shrink, and body weight declines.

Blurred vision:

Another diabetes symptom is blurred vision. A high level of blood glucose pulls fluid from all your tissues, including the lenses of your eyes. The decrease in fluid affects your ability to focus.

Fatigue:

A diabetes symptom that occurs when your cells are deprived of glucose, you become tired and irritable.

Diabetic emergencies:

People (usually with type 1 diabetes) may also experience episodes of diabetic ketoacidosis (DKA), a metabolic disturbance characterized by nausea, vomiting and abdominal pain, the smell of acetone on the breath, deep breathing known as Kussmaul breathing, and in severe cases a decreased level of consciousness. A rare but equally severe possibility is hyperosmolar hyperglycemic state (HHS), which is more common in type 2 diabetes and is mainly the result of dehydration. Treatment-related low blood sugar (hypoglycemia) is common in people with type 1 and also type 2 diabetes depending on the medication being used. Most cases are mild and are not considered medical emergencies. Effects can range from feelings of unease, sweating, trembling, and increased appetite in mild cases to more serious effects such as confusion, changes in behavior such as aggressiveness, seizures, unconsciousness, and rarely permanent brain damage or death in severe cases. Rapid breathing, sweating, and cold, pale skin are characteristic of low blood sugar but not definitive. Mild to moderate cases are self-treated by eating or drinking something high in sugar. Severe cases can lead to unconsciousness and must be treated with intravenous glucose or injections with glucagon.

Several other signs and symptoms can mark the onset of diabetes although they are not specific to the disease. In addition to the known ones above, they include headache and itchy skin. Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting in vision changes. Long-term vision loss can also be caused by diabetic retinopathy. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermatomes.
Type 2 diabetes has the same symptom as that of type 1 diabetes but may include these symptom:

Slow-healing sores or frequent infections:

This diabetes symptom affects your body's ability to heal and fight infection. Bladder and vaginal infections can be a particular problem for women.

Nerve damage (neuropathy):

This diabetes symptom is due to excess sugar in your blood that can damage the small blood vessels to your nerves. Symptom may include tingling and loss of sensation in your hands and feet, as well as burning pain in your arms, hands, legs and feet.

Red, swollen, tender gums:

This diabetes symptom is due to the infection in your gums and in the bones that hold your teeth in place. Your gums may pull away from your teeth, your teeth may become loose, or you may develop sores or pockets of pus in your gums - especially if you have a gum infection before diabetes develops.

Symptoms of Type 1 Diabetes:

People who have type 1 diabetes may also have nausea, vomiting, or stomach pains. Type 1 diabetes symptoms can develop in just a few weeks or months and can be severe. Type 1 diabetes usually starts when you’re a child, teen, or young adult but can happen at any age.

Symptoms of Type 2 Diabetes:

Type 2 diabetes symptoms often develop over several years and can go on for a long time without being noticed (sometimes there aren’t any noticeable symptoms at all). Type 2 diabetes usually starts when you’re an adult, though more and more children, teens, and young adults are developing it. Because symptoms are hard to spot, it’s important to know the risk factors for type 2 diabetes and visit your doctor if you have any of them.

Symptoms of Gestational Diabetes:

Gestational diabetes (diabetes during pregnancy) usually shows up in the middle of the pregnancy and typically doesn’t have any symptoms. If you’re pregnant, you should be tested for gestational diabetes between 24 and 28 weeks of pregnancy so you can make changes if needed to protect your health and your baby’s health.

Diabetes mellitus is characterized by recurrent or persistent high blood sugar, and is diagnosed by demonstrating any one of the following:

  • Fasting plasma glucose level ≥ 7.0 mmol/L (126 mg/dL).
  • Plasma glucose ≥ 11.1 mmol/L (200 mg/dL) two hours after a 75 gram oral glucose load as in a glucose tolerance test (OGTT).
  • Symptoms of high blood sugar and casual plasma glucose ≥ 11.1 mmol/L (200 mg/dL).
  • Glycated hemoglobin (HbA1C) ≥ 48 mmol/mol (≥ 6.5 DCCT %).
WHO diabetes diagnostic criteria
Condition2-hour glucoseFasting glucoseHbA1c
Unitmmol/Lmg/dLmmol/Lmg/dLmmol/molDCCT %
Normal< 7.8< 140< 6.1< 110< 42< 6.0
Impaired fasting glycaemia< 7.8< 1406.1–7.012642–466.0–6.4
Impaired glucose tolerance≥ 7.8≥ 140< 7.0< 12642–466.0–6.4
Diabetes mellitus≥ 11.1≥ 200≥ 7.0≥ 126≥ 48≥ 6.5

A positive result, in the absence of unequivocal high blood sugar, should be confirmed by a repeat of any of the above methods on a different day. It is preferable to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test. According to the current definition, two fasting glucose measurements above 7.0 mmol/L (126 mg/dL) is considered diagnostic for diabetes mellitus.

Per the WHO, people with fasting glucose levels from 6.1 to 6.9 mmol/L (110 to 125 mg/dL) are considered to have impaired fasting glucose. People with plasma glucose at or above 7.8 mmol/L (140 mg/dL), but not over 11.1 mmol/L (200 mg/dL), two hours after a 75 gram oral glucose load are considered to have impaired glucose tolerance. Of these two pre-diabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus, as well as cardiovascular disease. The American Diabetes Association (ADA) since 2003 uses a slightly different range for impaired fasting glucose of 5.6 to 6.9 mmol/L (100 to 125 mg/dL).

What is the proper blood sugar level?

The proper blood sugar level varies throughout the day and from person to person. People with diabetes often have higher blood sugar targets or acceptable ranges than people without the disease.
Ranges vary depending on a number of factors, including:

  • Age and life expectancy
  • The presence of other medical conditions
  • Diagnosed diabetes and its length
  • Other cardiovascular diseases
  • Artery problems
  • Damage to the eyes, kidneys, blood vessels, brain or heart
  • Personal habits and lifestyle factors
  • Other diseases

Blood sugar levels are often lowest before breakfast and before meals, and highest in the hours following meals. Most blood sugar charts present the recommended levels as a range, taking into account differences between individuals.

Blood sugar norms
Checking timeTarget blood sugar levels for people
without diabeteswith diabetes
Before meals100 mg / dL80–130 mg / dL
1-2 hours after starting the meal< 140 mg / dL< 180 mg / dL
For a period of 3 months (A1C test)< 5.7%< 7%
< 180 mg / dL

Some forms of temporary diabetes, such as gestational diabetes, also have separate blood sugar recommendations. Please consult your doctor for specific information.

All forms of diabetes increase the risk of long-term complications. These typically develop after many years (10–20) but may be the first symptom in those who have otherwise not received a diagnosis before that time.

The major long-term complications relate to damage to blood vessels. Diabetes doubles the risk of cardiovascular disease and about 75% of deaths in people with diabetes are due to coronary artery disease. Other macro vascular diseases include stroke, and peripheral artery disease.The primary complications of diabetes due to damage in small blood vessels include damage to the eyes, kidneys, and nerves. Damage to the eyes, known as diabetic retinopathy, is caused by damage to the blood vessels in the retina of the eye, and can result in gradual vision loss and eventual blindness. Diabetes also increases the risk of having glaucoma, cataracts, and other eye problems.

It is recommended that people with diabetes visit an eye doctor once a year. Damage to the kidneys, known as diabetic nephropathy, can lead to tissue scarring, urine protein loss, and eventually chronic kidney disease, sometimes requiring dialysis or kidney transplantation. Damage to the nerves of the body, known as diabetic neuropathy, is the most common complication of diabetes. The symptoms can include numbness, tingling, pain, and altered pain sensation, which can lead to damage to the skin. Diabetes-related foot problems (such as diabetic foot ulcers) may occur, and can be difficult to treat, occasionally requiring amputation. Additionally, proximal diabetic neuropathy causes painful muscle atrophy and weakness.

There is a link between cognitive deficit and diabetes. Compared to those without diabetes, those with the disease have a 1.2 to 1.5-fold greater rate of decline in cognitive function. Having diabetes, especially when on insulin, increases the risk of falls in older people.

There is no known preventive measure for type 1 diabetes. Type 2 diabetes, which accounts for 85–90% of all cases worldwide, can often be prevented or delayed by maintaining a normal body weight, engaging in physical activity, and eating a healthy diet. Higher levels of physical activity (more than 90 minutes per day) reduce the risk of diabetes by 28%. Dietary changes known to be effective in helping to prevent diabetes include maintaining a diet rich in whole grains and fiber, and choosing good fats, such as the polyunsaturated fats found in nuts, vegetable oils, and fish. Limiting sugary beverages and eating less red meat and other sources of saturated fat can also help prevent diabetes. Weight loss, if you are overweight, losing 5% - 7% of your weight. Tobacco smoking is also associated with an increased risk of diabetes and its complications, so smoking cessation can be an important preventive measure as well.

The relationship between type 2 diabetes and the main modifiable risk factors (excess weight, unhealthy diet, physical inactivity and tobacco use) is similar in all regions of the world. There is growing evidence that the underlying determinants of diabetes are a reflection of the major forces driving social, economic and cultural change: globalization, urbanization, population aging, and the general health policy environment.

Diabetes management concentrates on keeping blood sugar levels as close to normal, without causing low blood sugar. This can usually be accomplished with dietary changes, exercise, weight loss, and use of appropriate medications (insulin, oral medications).Learning about the disease and actively participating in the treatment is important, since complications are far less common and less severe in people who have well-managed blood sugar levels. Per the American College of Physicians, the goal of treatment is an HbA1C level of 7-8%.

Attention is also paid to other health problems that may accelerate the negative effects of diabetes. These include smoking, high blood pressure, metabolic syndrome obesity, and lack of regular exercise. Specialized footwear is widely used to reduce the risk of ulcers in at-risk diabetic feet although evidence for the efficacy of this remains equivocal.

To control and manage type 1 diabetes, you need to inject insulin regularly, up to eight times per day. You must also test your blood sugar frequently, using a home blood-sugar monitor. You use that information, in consultation with your doctor to regulate your insulin dosage, diet and exercise.

Treatment of type 2 diabetes also starts with home blood-sugar monitor testing. But only a fraction of people with type 2 diabetes need insulin injections. Most can be controlled with blood sugar dietary changes, healthy diet, regular physical exercise and oral medications, a normal body weight, and avoiding use of tobacco. Type 2 diabetes may be treated with medications such as insulin sensitizers with or without insulin. Control of blood pressure and maintaining proper foot and eye care are important for people with the disease. Insulin and some oral medications can cause low blood sugar. Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 diabetes. Gestational diabetes usually resolves after the birth of the baby.

If you are diagnosed with type 1 diabetes or type 2 diabetes, you should definitely must be under doctor’s care and management. And you should never stop using your medications or injections, or alter your dosage, without your doctor’s approval.

To enjoy a healthier lifestyle even if you are afflicted with diabetes, you may follow some simple suggestions using blended medicine. Though the following suggestions are more tailored for type 2 diabetes.

Glucose Control:

Most medications used to treat diabetes act by lowering blood sugar levels through different mechanisms. There is broad consensus that when people with diabetes maintain tight glucose control – keeping the glucose levels in their blood within normal ranges – they experience fewer complications, such as kidney problems or eye problems. There is however debate as to whether this is appropriate and cost effective for people later in life in whom the risk of hypoglycemia may be more significant.

There are a number of different classes of anti-diabetic medications. Type 1 diabetes requires treatment with insulin, typically with a combination of regular and NPH insulin, or synthetic insulin analogs. Type 2 diabetes may also be treated with insulin at later stages. Some medications for type 2 diabetes are taken by mouth, such as metformin, while others are only administered by injection, such as GLP-1 agonists.

Metformin:

Is generally recommended as a first-line treatment for type 2 diabetes, as there is good evidence that it decreases mortality. It works by decreasing the liver's production of glucose. Several other groups of drugs, mostly given by mouth, may also decrease blood sugar in type 2 diabetes. These include agents that increase insulin release (sulfonylureas), agents that decrease absorption of sugar from the intestines (acarbose), agents that inhibit the enzyme dipeptidyl peptidase-4 (DPP-4) that inactivates incretins such as GLP-1 and GIP (sitagliptin), agents that make the body more sensitive to insulin (thiazolidinedione) and agents that increase the excretion of glucose in the urine (SGLT2 inhibitors). When insulin is used in type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications. Doses of insulin are then increased until glucose targets are reached.

Blood Pressure Lowering:

Cardiovascular disease is a serious complication associated with diabetes, and many international guidelines recommend blood pressure treatment targets that are lower than 140/90 mmHg for people with diabetes. However, there is only limited evidence regarding what the lower targets should be. A 2016 systematic review found potential harm to treating to targets lower than 140 mmHg, and a subsequent systematic review in 2019 found no evidence of additional benefit from blood pressure lowering to between 130 - 140mmHg, although there was an increased risk of adverse events.

2015 American Diabetes Association recommendations are that people with diabetes and albuminuria should receive an inhibitor of the renin-angiotensin system to reduce the risks of progression to end-stage renal disease, cardiovascular events and death. There is some evidence that angiotensin converting enzyme inhibitors (ACEIs) are superior to other inhibitors of the renin-angiotensin system such as angiotensin receptor blockers (ARBs) or aliskiren in preventing cardiovascular disease. Although a more recent review found similar effects of ACEIs and ARBs on major cardiovascular and renal outcomes. There is no evidence that combining ACEIs and ARBs provides additional benefits.

Lifestyle:

People with diabetes can benefit from education about the disease and treatment, dietary changes, and exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure.

Weight Loss:

Can prevent progression from pre-diabetes to diabetes type 2, decrease the risk of cardiovascular disease, or result in a partial remission in people with diabetes. No single dietary pattern is best for all people with diabetes. Healthy dietary patterns, such as the Mediterranean diet, low-carbohydrate diet, or DASH diet are often recommended, although evidence does not support one over the others. According to the ADA, "reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia", and for individuals with type 2 diabetes who cannot meet the glycemic targets or where reducing anti-glycemic medications is a priority, low or very-low carbohydrate diets are a viable approach. For overweight people with type 2 diabetes, any diet that achieves weight loss is effective.

Weight loss surgery in those with obesity and type 2 diabetes is often an effective measure. Many are able to maintain normal blood sugar levels with little or no medications following surgery and long-term mortality is decreased. There is, however, a short-term mortality risk of less than 1% from the surgery. The body mass index cutoffs for when surgery is appropriate are not yet clear. It is recommended that this option be considered in those who are unable to get both their weight and blood sugar under control.

A pancreas transplant is occasionally considered for people with type 1 diabetes who have severe complications of their disease, including end stage kidney disease requiring kidney transplantation.

Nutrition and Diet for Diabetes:

For diabetes management and control, it is generally advised that the person should start to make adjustments on his lifestyle. This include maintaining a simple diet, eating foods that are less saturated with fat and cholesterol. By reducing or eliminating animal products and eating more fiber-rich plant foods such as whole grains, beans, fruits, and vegetables.

Eat a lot of foods that are rich in anti-oxidants. Plant-derived foods are rich in the anti-oxidant nutrient including beta-carotene and vitamin C and E. Anti-oxidants neutralize free radicals, preventing this unstable oxygen molecules from damaging healthy cells. Free radicals not only lay the groundwork for the most serious complications of diabetes, they are also the cause of high blood sugar level. Include fiber-rich food to your diet. Foods that is rich in fiber helps in controlling the blood sugar level. It works by holding the nutrient in the digestive tract longer, allowing a slower absorption rate and reducing blood sugar ups and downs. Soy products and Tofu can also help people with diabetes. Soy is a good source of amino acids, glycine and arginine, that help block the body’s synthesis of cholesterol. Low levels of magnesium have been established in certain studies to be a factor in developing diabetes. Beef up your diet with magnesium rich food such as grains, nuts, and leafy green vegetables.

You may also take vitamin, mineral supplements and herbs to help you in diabetes management and control:

Vitamin E:

By taking vitamin E, diabetes patients may manage and prevent its complications. Clinical nutritionists normally recommend taking 600 to 800 international units (IU) a day. But be cautioned that taking vitamin E more than 400 IU should be taken under doctor’s supervision.

Chromium:

The mineral chromium plays a key role in the manufacture of insulin and in the maintenance of blood sugar with normal range. Normal recommended dosage is from 400 to 600 micrograms per day. But you must have your doctor’s approval before taking chromium supplement.

Zinc:

Several studies have shown that animals deprived with zinc develop high blood sugar. Other studies have determined that diabetes increases the excretion of zinc in urine, reducing the amount of the mineral in your blood. Normal recommended dose is at 30 to 50 milligrams per day and should be taken under medical supervision.

Magnesium:

As mentioned earlier, magnesium helps in controlling high blood sugar content. If you feel like you are not taking enough magnesium from your diet, you may take in some extra magnesium supplements. Normal suggested dose is at 20 to 30 milligrams a day.

Borage Oil and Primrose Oil:

These oils contain gamma-linoleic acid, which improves blood circulation through your small blood vessels. These small blood vessels are the ones that are normally blocked if you have chronically high blood-sugar level. A good number of patients with high blood sugar levels have shown remarkable improvements after taking borage oil and primrose oil every day. Ask your doctor for a dosage.

Herbal Medicine:

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Support:

In countries using a general practitioner system care may take place mainly outside hospitals, with hospital-based specialist care used only in case of complications, difficult blood sugar control, or research projects. In other circumstances, general practitioners and specialists share care in a team approach. Home telehealth support can be an effective management technique.

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