The Stages of Diabetes: A Guide

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Let's talk about diabetes.

Glucose into CellsDiabetes is the name for a group of diseases that are characterized by high blood glucose, which is also known as high blood sugar or hyperglycemia. It's a metabolic disorder in which "the body doesn’t make enough insulin or is not able to use insulin effectively, or both" (source). You see, when you eat most foods, your body breaks them down into glucose. Then your body uses insulin to get the glucose into your cells, where it is converted into energy. When this process is disrupted, there's too much glucose left in your bloodstream, and this can cause a variety of complications.

There are many different types of diabetes. They include...

  • Type 1 diabetes
  • Type 2 diabetes
  • Gestational diabetes

Type 1 diabetes usually occurs in children or young adults and only accounts for about 5% of total diabetes cases (source). It is caused by the body's immune system attacking beta cells in the pancreas, which were supposed to produce insulin. It used to be called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, but now it is most commonly known as type 1 diabetes. Type 1 diabetes is relatively rare and its cause is unknown.

Check Your Blood at the Doctor's OfficeGestational diabetes can occur in women during pregnancy. According to the National Diabetes Information Clearinghouse (NDIC), "Scientists believe gestational diabetes is caused by the hormonal changes and metabolic demands of pregnancy together with genetic and environmental factors." It develops in roughly 2-10% of pregnancies and typically goes away after delivery, though it may increase the mother and/or child's risk of diabetes later in life.

But we're not here to talk about those types of diabetes. Today, it's time to focus on type 2 diabetes.

Type 2 diabetes accounts for 90-95% of all diabetes cases. It used to be called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. The NDIC asserts, "Type 2 diabetes—the most common form of diabetes—is caused by a combination of factors, including insulin resistance, a condition in which the body’s muscle, fat, and liver cells do not use insulin effectively. Type 2 diabetes develops when the body can no longer produce enough insulin to compensate for the impaired ability to use insulin."

PrediabetesThere are 2 stages of type 2 diabetes -- prediabetes, and full-blown type 2 diabetes. Let's take a look at these stages!

Prediabetes occurs when someone has "blood sugar, levels that are higher than normal but not high enough to be called diabetes" (source). Often the symptoms of prediabetes are subtle or even nonexistent. According to the U.S. National Library of Medicine, "Most people with prediabetes don’t have any symptoms. Your doctor can test your blood to find out if your blood glucose levels are higher than normal. If you are 45 years old or older, your doctor may recommend that you be tested for prediabetes, especially if you are overweight."

So what are the actual test results that indicate whether a person has prediabetes? The NDIC has laid them all out, explaining that a person with prediabetes would have "an A1C level of 5.7 to 6.4 percent; a fasting plasma glucose test result of 100–125 mg/dL, called impaired fasting glucose; or a 2-hour oral glucose tolerance test result of 140–199, called impaired glucose tolerance."

Prediabetes not only increases your risk of developing type 2 diabetes, but it also increases your risk of heart disease and stroke (source). Yet "Progression to diabetes among those with prediabetes is not inevitable. Studies suggest that weight loss and increased physical activity among people with prediabetes prevent or delay diabetes and may return blood glucose levels to normal" (source). In fact, it appears as though regular exercise actually helps the insulin in your body work better (source). A comprehensive clinical research study called the Diabetes Prevention Program (DPP) has been widely cited in discussions of ways to reduce a person's risk of diabetes. Perhaps the NDIC said it best when it explained,

Make Balanced Choices"The DPP proved that people with prediabetes—at high risk of developing type 2 diabetes—could sharply lower their risk by losing weight through regular physical activity and a diet low in fat and calories. In 2009, a follow-up study of DPP participants—the Diabetes Prevention Program Outcomes Study (DPPOS)—showed that the benefits of weight loss lasted for at least 10 years after the original study began"

That's heartening news! By following a low-fat, low-calorie diet and getting regular exercise, people can actually reduce their risk of diabetes, even when they have prediabetes!

Type 2 diabetes, the second stage we're exploring today, can develop from prediabetes. "Type 2 diabetes usually begins with insulin resistance—a condition that occurs when fat, muscle, and liver cells do not use insulin to carry glucose into the body’s cells to use for energy. As a result, the body needs more insulin to help glucose enter cells" (source). People are at a higher risk for developing type 2 diabetes when they are...

  • Age 45 or older
  • Dealing with impaired glucose tolerance
  • Obese
  • Physically inactive
  • Related to other people with diabetes

Risk of DiabetesThe CDC also asserts that "African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for type 2 diabetes."

Of these risk factors, the ones most highlighted by researchers are obesity and physical inactivity. The NDIC maintains "Physical inactivity and obesity are strongly associated with the development of type 2 diabetes" while the CDC explains "A number of studies have shown that regular physical activity can significantly reduce the risk of developing type 2 diabetes. Type 2 diabetes is associated with obesity."

But what is the impact of diabetes on health? Like prediabetes, people with type 2 diabetes are at an increased risk of heart disease and stroke. It can also cause blindness and kidney failure. Plus, type 2 diabetes has been linked to lower-extremity amputations. According to the CDC, it is the 7th leading cause of death in the U.S.

Let's take a moment to zoom in on the connection between diabetes and heart disease. "The most serious problem caused by diabetes is heart disease. When you have diabetes, you are more than twice as likely as people without diabetes to have heart disease or a stroke. With diabetes, you may not have the usual signs or symptoms of a heart attack" (source).

Get Active!Yet there is a ray of hope. Just like with prediabetes, healthful choices and regular exercise can help people with type 2 diabetes reduce their risk of complications. It can also help people prevent type 2 diabetes in the first place. The CDC offers a reminder about the DPP, explaining, "The Diabetes Prevention Program (DPP), a major federally funded study of 3,234 people at high risk for diabetes, showed that people can delay and possibly prevent the disease by losing a small amount of weight (5 to 7 percent of total body weight) through 30 minutes of physical activity 5 days a week and healthier eating."

And that brings us to the end of our exploration of the stages of diabetes. Here's a free handout with the highlights from this research review.

Stages of Diabetes

For More Information from Food and Health:

For More Information from Around the Web:

  • Basics About Diabetes from the Centers for Disease Control and Prevention (CDC)
  • Causes of Diabetes from the National Diabetes Information Clearinghouse (NDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and National Institutes of Health (NIH)
  • Diabetes: An A-Z List of Topics and Titles from the NDIC
  • Diabetes Home from the CDC
  • Prediabetes from Medline Plus, a service of the U.S. National Library of Medicine from the National Institutes of Health (NIH)
  • Preventing Diabetes from the CDC
  • Your Guide to Diabetes: Type 1 and Type 2 from the NDIC

More Diabetes Resources:

12 Lessons of Diabetes Program
Diabetes Poster Value Set
Diabetes Risk Banner and Stand

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