Diabetes is most commonly known as Type 1 and Type 2 diabetes. However, there are also gestational diabetes and other specific types of diabetes associated with genetic defects, with various diseases that injure the pancreas, or with drugs or chemicals, which may induce diabetes. In addition, you may be diagnosed with impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)—a metabolic stage between normal glucose balance and full-scale diabetes. People with IGT and IFG are now referred to as having “pre-diabetes.” Pre-diabetes is not a clinical entity in its own right, but rather a risk factor for future diabetes, as well as cardiovascular disease.
Type 1 Diabetes
Typically diagnosed in childhood and with most cases occurring before the age of 30, type 1 diabetes can occur at any age, even in the eighth and ninth decades of life, and is the end result of an autoimmune attack. Special kinds of cells in the pancreas called beta cells are destroyed, and this means the individual can no longer produce insulin and must rely on medication (insulin) to survive. While less common (just 10 percent of all diabetics in the United States have either Type 1, gestational diabetes, or other specific types of diabetes mentioned earlier), Type 1 diabetes is also the most serious. Symptoms include weight loss, frequent urination, and thirst. If it's untreated, these same signs and symptoms can occur, along with nausea, dehydration, and vomiting.
Once diagnosed, it is imperative that blood-sugar levels be well-controlled or a number of complications, including loss of vision and kidney disease, can occur. Those with Type 1 diabetes are also at an increased risk for hypertension, stroke, heart disease, and problems with the teeth and gums. So obviously, keeping a vigilant watch on blood-sugar numbers is a constant challenge for those with Type 1 diabetes.
Are you obese, overweight, or just right?
Don't rely on your bathroom scale for the answer. Experts now assess both obesity and overweight using the body mass index (BMI) because they believe that it yields a more accurate measure of total body fat than weight does.
Abdominal fat distribution—an increased percentage of body fat distributed around the belly region—is also associated with insulin resistance and therefore, an increased risk for type 2 diabetes. And you don't have to be obese to fall into this category. Abdominal obesity is defined by waist circumference over 102 cm for men (40 inches) and over 88 cm for women (over 35 inches).
Type 2 Diabetes
Ninety percent of Americans with diabetes have this type, which is generally less serious than Type 1. Patients may not make enough insulin, and/or they may be resistant to the insulin that they do produce. In individuals with Type 2 diabetes, the insulin that should be produced after a meal can be decreased by as much as 50 percent. People with Type 2 usually don't have to take insulin right after diagnosis, and they may never need to. Doctors generally first prescribe a change in diet, an increase in exercise, and often times, oral medication. With Type 2, unlike Type 1, autoimmune destruction of the cells is not present.
Type 2 diabetes is often called the silent disease because out of the nearly 16 million people in this country who have it, nearly one third don't know it. In fact, Type 2 diabetes is present on average for about six and one half years before diagnosis. And even though at the time of diagnosis most Type 2 patients don't even have symptoms, they are still at significant risk for coronary heart disease, stroke, and peripheral vascular disease.
The risk of developing Type 2 diabetes climbs with age, and is typically diagnosed after the age of 30. However, don't be so sure your child won't develop the disorder. Increasingly, it's being diagnosed in children and teenagers, and some authorities are predicting an epidemic among young people. What's more, Type 2 diabetes goes hand in hand with obesity. About 80 percent of Type 2 patients are obese at the time of diagnosis. Unfortunately, a growing percentage of our younger population falls into this category.
About 4 percent of pregnancies in the United States are complicated by gestational diabetes (GDM). This disorder, which affects 135,000 women each year, is defined as any degree of glucose intolerance during pregnancy. Most women with GDM will have a completely normal blood glucose after the baby is born, although a history of GDM means a woman is at risk for developing the disorder in subsequent pregnancies, and for possibly developing Type 2 diabetes later in life.