Overview

Diabetes is a chronic disease marked by high levels of sugar in the blood. Diabetes can be caused by too little insulin, resistance to insulin, or both. The three types of diabetes are:

  • Type 1 diabetes (also called insulin-dependent or juvenile diabetes)
  • Type 2 diabetes (also called non-insulin dependent diabetes mellitus)
  • Gestational diabetes

Type 1 diabetes

Type 1 diabetes may also be known by a variety of other names, including the following:

  • Insulin-dependent diabetes mellitus (IDDM)
  • Juvenile diabetes

There are two forms of type 1 diabetes:

  • Idiopathic type 1 diabetes. This refers to rare forms of the disease with no known cause.
  • Immune-mediated diabetes. An autoimmune disorder in which the body's immune system destroys, or attempts to destroy, the cells in the pancreas that produce insulin.

Immune-mediated diabetes is the most common form of type 1 diabetes, and the one generally referred to as type 1 diabetes. The information on this page refers to this form of type 1 diabetes.

Type 1 diabetes accounts for about five percent of all diagnosed cases of diabetes in the U.S. Type 1 diabetes usually develops in children or young adults, but can start at any age.

Causes

The cause of type 1 diabetes is unknown, but it is believed to result from the immune system being triggered. The body's immune system attacks and destroys the insulin producing cells in the pancreas. Insulin allows glucose to enter the cells of the body to provide energy.

When glucose cannot enter the cells, it builds up in the blood, depriving the cells of nutrition. People with type 1 diabetes must take daily insulin injections and regularly monitor their blood sugar levels.

Symptoms

Type 1 diabetes often appears suddenly. The following are the most common symptoms of type 1 diabetes. However, each individual may experience symptoms differently. Symptoms may include:

  • Unusual thirst
  • Frequent urination
  • Unexplained weight loss despite extreme hunger
  • Blurred vision
  • Nausea and vomiting
  • Extreme weakness and fatigue
  • Irritability and mood changes

In children, symptoms may be similar to those of having the flu. Some very young children may start bedwetting again.

The symptoms of type 1 diabetes may resemble other conditions or medical problems. Always consult a doctor for a diagnosis.

Complications

Type 1 diabetes can cause many different problems. However, the three key complications of diabetes include the following:

  • Kidney failure
  • Blindness
  • Ketoacidosis (high blood sugar and a buildup of acids in the blood due to untreated or undertreated diabetes)
  • Heart attack
  • Stroke
  • Foot ulcers
  • Amputations

Treatment

Treatment of type 1 diabetes requires insulin. A patient’s specific type of insulin plan will be determined by their doctor based on:

  • Age, overall health, and medical history
  • Extent of the disease
  • Tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Patient opinion or preference
  • Cost of therapy

People with type 1 diabetes must have daily injections of insulin to keep their blood sugar level within normal ranges. Other parts of the treatment protocol may include:

  • Appropriate diet (to manage blood sugar levels)
  • Exercise (to lower and help the body use blood sugar)
  • Careful self-monitoring of blood sugar levels several times a day and keeping a log, as directed by a doctor
  • Careful self-monitoring of ketone levels in the urine several times a day, as directed by a doctor
  • Regular monitoring of the hemoglobin A1c levels

The hemoglobin A1c test (also called HbA1c test) shows the average amount of sugar in the blood over the last three months. The result will indicate if the blood sugar level is under control. The frequency of HbA1c testing will be determined by a doctor. The American Diabetes Association (ADA) recommends that testing occur at least twice a year if the blood sugar level is in the target range and stable, and more frequently if the blood sugar level is unstable. Most people with type 1 diabetes require three monthly HbA1c tests.

Advances in diabetes research have led to improved methods of managing diabetes and treating its complications. However, scientists continue to explore the causes of diabetes and ways to prevent and treat the disorder.

Type 2 diabetes

Type 2 diabetes is a metabolic disorder resulting from the body's inability to make enough insulin for the degree of insulin resistance (body's inability to properly use insulin). It used to be called non-insulin-dependent diabetes mellitus, or maturity-onset diabetes mellitus (NIDDM).

Without adequate production or utilization of insulin, the body cannot move blood sugar into the cells. It is a chronic disease that has no known cure. It is the most common type of diabetes.

Prediabetes

Type 2 diabetes is commonly preceded by prediabetes. In prediabetes, blood glucose levels are higher than normal but not high enough to be defined as diabetes. However, many people with prediabetes develop type 2 diabetes within 10 years, states the National Institute of Diabetes and Digestive and Kidney Diseases. Prediabetes also increases the risk of heart disease and stroke. With modest weight loss and moderate physical activity, people with prediabetes can delay or prevent type 2 diabetes.

Prediabetes affects 79 million people in the U.S., according to the ADA.

Causes

The exact cause of type 2 diabetes is unknown. However, there does appear to be a genetic factor which causes it to run in families. Although a person can inherit a tendency to develop type 2 diabetes, it usually takes another factor, such as obesity or physical inactivity, to bring on the disease.

Prevention

Type 2 diabetes may be prevented or delayed by following a program to eliminate or reduce risk factors--particularly losing weight (as little as five to 10 percent) and increasing exercise (30 minutes a day, five days a week). Information gathered by the Diabetes Prevention Program, sponsored by the National Institutes of Health and the ADA, continues to study this possibility.

Symptoms

Most people with type 2 diabetes have no symptoms. It is usually diagnosed on blood tests during routine clinical evaluations. However, each individual may experience symptoms differently. Symptoms may include:

  • Frequent infections that do not heal easily
  • Unusual thirst
  • Frequent urination
  • Weight loss despite extreme hunger
  • Blurred vision
  • Nausea and vomiting
  • Extreme weakness and fatigue
  • Irritability and mood changes
  • Dry, itchy skin
  • Tingling or loss of feeling in the hands or feet

Some people who have type 2 diabetes exhibit no symptoms. Symptoms may be mild and almost unnoticeable, or easy to confuse with signs of aging. Half of all Americans who have diabetes do not know it.

The symptoms of type 2 diabetes may resemble other conditions or medical problems. Always consult a doctor for a diagnosis.

Risk factors

Risk factors for type 2 diabetes include:

  • Age. People over the age of 45 are at higher risk for diabetes.
  • Family history of diabetes
  • Being overweight
  • Not exercising regularly
  • Race and ethnicity. Being a member of certain racial and ethnic groups, such as African-Americans, Hispanic Americans, and American Indians increases the risk for type 2 diabetes.
  • Pregnancy
  • History of gestational diabetes, or giving birth to a baby who weighed more than nine pounds
  • A low level HDL ("good") cholesterol
  • A high triglyceride level

Treatment

Specific treatment for type 2 diabetes will be determined by a doctor based on:

  • Age, overall health, and medical history
  • Extent of the disease
  • Tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Patient opinion or preference
  • Cost of therapy

The goal of treatment is to keep blood sugar levels as close to normal as safely possible. Emphasis is on control of blood sugar (glucose) by monitoring the levels, regular physical activity, meal planning, and routine health care. Treatment of diabetes is an ongoing process of management and education that includes not only the person with diabetes, but also health care professionals and family members.

Often, type 2 diabetes can be controlled through losing weight, improved nutrition, and exercise alone. However, over time, these measures are not enough and either oral or injected medications and/or insulin must be used. Treatment often includes:

  • Proper diet
  • Weight control
  • An appropriate exercise program
  • Regular foot inspections
  • Oral medications, other medications, and/or insulin replacement therapy, as directed by a doctor. There are various types of medications that may be used to treat type 2 diabetes when lifestyle changes, such as diet, exercise, and weight loss are no longer effective. Oral medications of several different types are available, with each type working in a different manner to lower blood sugar and each one with different side effects. One medication may be combined with another one to improve blood sugar control. When oral medications are no longer effective, insulin may be required. New medications for treating diabetes are in development.
  • Regular monitoring of the hemoglobin A1c levels. The hemoglobin A1c test (also called HbA1c test) shows the average amount of sugar in the blood over the last three months. The result will indicate if the blood sugar level is under control. The frequency of HbA1c testing will be determined by a doctor. It is recommended that testing occur at least twice a year if the blood sugar level is in the target range and stable, and more frequently if the blood sugar level is unstable.

Untreated or inappropriately treated diabetes can cause problems with the kidneys, legs, feet, eyes, heart, nerves, and blood flow, which could lead to kidney failure, gangrene, amputation, blindness, heart attack or stroke. For these reasons, it is important to follow a strict treatment plan.

Gestational diabetes

Learn more about gestational diabetes.

Diagnosis

The physician will begin with a physical exam and medical history. If diabetes is suspected, the physician may order one or more of the following tests:

  • Blood glucose test
  • A1C test to measure average blood glucose levels over the past 2 to 3 months
  • Fasting plasma glucose test to measure blood glucose levels when the patient has not eaten for at least 8 hours
  • Oral glucose tolerance test to measure the body’s response to a sweet drink

Treatment

Because there is no cure for diabetes, the goal of treatment is to manage the symptoms to prevent complications. Diabetes specialists at North Shore-LIJ may recommend any of the following treatment options:

  • Lifestyle changes to control weight, including:
    • Eating a healthy, low-sugar diet
    • Getting regular physical activity
  • Insulin injections for people with type 1 diabetes
  • Oral medications and/or insulin injections for people with type 1 diabetes, if uncontrolled through lifestyle changes

Services

North Shore-LIJ Health System has an experienced team with specific training in diabetes that provides a range of care and services. From comprehensive inpatient care to specialized foot and wound services, patients can feel confident that they are receiving world-class care for all aspects of the condition.

Inpatient Care for Diabetes at North Shore-LIJ

When people need inpatient care to manage their diabetes, physicians at North Shore University Hospital and Long Island Jewish Medical Center are ready. Dedicated diabetes physicians consult with other North Shore-LIJ medical staff to provide comprehensive inpatient care. The multidisciplinary team includes:

  • Endocrinologists (physicians who specializes in disorders of the glands and hormones)
  • Certified nurse practitioners
  • Certified diabetes educators who are nurses, registered dietitians, physical therapists and pharmacists
  • Certified wound care nurses
  • Vascular surgeons
  • Weight management consultants

The diabetes team at North Shore-LIJ is well known for excellence in diabetes care. The Joint Commission has certified both North Shore University Hospital and Long Island Jewish Medical Center for their superior inpatient diabetes programs.

Diabetic Foot Care at North Shore-LIJ

Diabetes can lead to neuropathy (nerve damage) and blood vessel problems, especially in the legs and feet.

People who have nerve damage and poor circulation in their legs may not notice injuries or sores until they worsen. If these injuries are left untreated, they can result in serious ulcerations, infections and even amputation. Proper foot care is critical to help prevent serious infections and amputations.

At North Shore-LIJ, the podiatry services provide specialized care for people with diabetes. Podiatrists are physicians who specialize in treating conditions that affect the foot, ankle and related structures of the leg. They can check patients’ feet regularly for any problems and show them and their caregivers proper foot care.

Diabetic Wound Care at North Shore-LIJ

Wound care specialists treat acute and chronic, hard-to-heal wounds that many people with diabetes experience. With highly specialized care designed specifically for wounds resulting from diabetes, the goals are to heal wounds, preserve limbs, and prevent wounds from recurring.

The experienced staff at North Shore-LIJ has advanced, specialized training in the latest wound care therapies, including technology, techniques and medication. The dedicated nursing staff manages all aspects of patient care, including:

  • Coordinating wound care among disciplines
  • Referring patients to home care services
  • Monitoring the healing progress

The multidisciplinary team for wound care includes:

  • Surgeons who specialize in podiatry, vascular (blood vessels) surgery, plastic surgery and general surgery
  • Wound care–certified nurses and nurse practitioners
  • Physical therapists and orthotists (physicians specializing in artificial limbs)
  • Infectious disease specialists
  • Home care specialists
  • Certified hyperbaric medicine physicians for oxygen chamber treatment of wounds