Diabetes Types

In type 1 diabetes, the pancreas does not produce insulin. Insulin is a hormone that is involved in regulating how the body converts sugar (glucose) into energy. People with type 1 diabetes must take insulin injections daily and carefully monitor their blood glucose levels. Type 1 diabetes is much less common than type 2 diabetes. It accounts for 5-10% of all cases of diabetes. Type 1 diabetes can occur at any age, but usually develops in childhood or adolescence.

Symptoms of type 1 diabetes include:

• Frequent urination
• Excessive thirst
• Extreme hunger
• Sudden weight loss
• Extreme fatigue
• Irritability
• Blurred vision

If you have any of these symptoms, please consult your primary care doctor. If you do not have a primary care physician, we can help you find one.

Type 2 diabetes is a lifelong disease in which there are high levels of sugar (glucose) in the blood. Type 2 diabetes is the most common form of diabetes.

Diabetes is caused by a problem in the way your body makes or uses insulin. Insulin is needed to move blood sugar (glucose) into cells, where it is stored and later used for energy. When you have type 2 diabetes, your fat, liver, and muscle cells do not respond correctly to insulin. This is called insulin resistance. As a result, blood sugar does not get into these cells to be stored for energy. When sugar cannot enter cells, high levels of sugar build up in the blood. This is called hyperglycemia.

Type 2 diabetes usually occurs slowly over time. Most people with the disease are overweight when they are diagnosed. Increased fat makes it harder for your body to use insulin the correct way. Type 2 diabetes can also develop in people who are thin. This is more common in the elderly. Family history and genes play a large role in type 2 diabetes. Low activity level, poor diet, and excess body weight around the waist increase your risk.

Type 2 Diabetes Symptoms

Often, people with type 2 diabetes have no symptoms at first. They may not have symptoms for many years. The early symptoms of diabetes may include:

• Bladder, kidney, skin, or other infections that are more frequent or heal slowly
• Fatigue
• Hunger
• Increased thirst
• Increased urination
• Blurred vision
• Erectile dysfunction
• Pain or numbness in the feet or hands

If you are experiencing any of these symptoms, please contact your primary care doctor. If you do not have a primary care physician, we can help you find one.

At CHI Health, we are committed to support women with or at risk for diabetes. In partnership with your provider, our diabetes education team of nurses and dietitians provide a variety of outpatient diabetes education and support from pre-pregnancy through pregnancy into the postpartum period

What is Gestational Diabetes?

Gestational diabetes is a type of diabetes that happens during pregnancy. Unlike type 1 diabetes, gestational diabetes is not caused by having too little insulin. Instead a hormone made by your placenta keeps your body from using the insulin as it should. This is called insulin resistance. Blood sugar (glucose) then builds up in your blood instead of being absorbed by the cells in your body.

What are the symptoms of gestational diabetes?

Gestational diabetes does not cause any symptoms. That’s why it’s important to get tested for it if you are at high risk. If your blood sugar levels are very high, you may have these symptoms:

• You urinate more than normal
• You are hungrier or thirstier than normal.
• You have blurred vision
• You have nausea and vomiting
• You lose weight even though you are hungrier

How is gestational diabetes diagnosed?

You should be tested for gestational diabetes in your 24th to 28th week of pregnancy. The American Diabetes Association also recommends that you be tested for type 2 diabetes if you have risk factors for this condition. This testing should be done at your first prenatal visit. Screening is done by these tests:

• One-hour glucose tolerance test. You drink a special beverage high in sugar. One hour later, the healthcare provider measures your blood sugar (glucose) levels. If your levels are higher than a certain level, this is considered an abnormal result.
• Three-hour glucose tolerance test. If the 1-hour test is abnormal, you will have a second glucose tolerance test done to confirm the diagnosis. You will drink another special beverage, but with more sugar. Your healthcare provider will measure your blood sugar levels 1 hour, 2 hours, and 3 hours later. You have gestational diabetes if at least two of the glucose measurements are higher than normal.

If you are diagnosed with gestational diabetes, you should get tested for diabetes 4 to 12 weeks after your baby is born. You should also get this screening at least every three years for the rest of your life.

What is the treatment for gestational diabetes?

Treatment for gestational diabetes focuses on keeping your blood sugar levels in the normal range. Treatment may include:

• Special diet. You should eat 5 servings of vegetables, fruits, low-fat or nonfat dairy products, and lean meats. Use liquid fats for cooking instead of solid fats. You should eat whole grains and avoid high-calorie snacks or sweet desserts.
• Exercise. You should do moderate exercise unless your healthcare provider tells you not to.
• Daily blood glucose monitoring. Your goal is to keep your blood sugar levels lower than 130mg/dL to 140mg/dL one hour after eating.
• Insulin injections. You may need these to control your blood sugar levels. Or you may need other medicines taken by mouth.

Our Gestational Diabetes Education program will assist you with your special diabetes management needs during pregnancy. The program consists of:

• Nutrition education including an individualized meal plan with one or more sessions with the registered dietitian.
  
• Self-management education including blood sugar monitoring, sick day care, target blood sugars, and physical activity.

More than 1 in 3 Americans has prediabetes, and most don’t know they have it. Diagnosis is important because the long-term damage type 2 diabetes causes in the heart and kidneys, for example, can start when you have prediabetes. Without lifestyle changes, prediabetes can advance to type 2 diabetes. A simple blood test can determine if you have prediabetes or type 2 diabetes.

Blood Sugar Level:

• Prediabetes 140-199 mg/dL
• Type 2 diabetes 200 mg/dL or higher

Prediabetes and type 2 diabetes is caused by the same problem with the way your body makes and uses insulin. Insulin moves blood sugar (glucose) into cells, where it is stored and later used for energy. When you have prediabetes, your fat, liver and muscle cells do not respond correctly to insulin, causing insulin resistance. As a result, blood sugar does not get into these cells to be stored for energy. When sugar cannot enter cells, high levels of sugar build up in the blood. This is called hyperglycemia.

This can occur for years with no clear symptoms, making prediabetes hard to detect. Risk factors have been identified which help providers determine who should have their blood sugar tested. These include:

• Being overweight
• Waist size larger than 45 inches for women, 35 inches for men
• Age 45 years or older
• Type 2 diabetes in parent or sibling
• Sedentary lifestyle (physical activity less than 3 times/week)
• Diet high in red or processed meats, sugar-sweetened beverages 
• History of gestational diabetes
• History of polycystic ovary syndrome
• History of obstructive sleep apnea
• History of smoking
• Race (African American, Hispanic/Latino American, American Indian, Pacific Islander, some Asian Americans are at higher risk) 

The good news is prediabetes can generally be reversed by eating a healthy diet, getting regular exercise and maintaining a healthy weight. Talk to your provider if you have any risk factors. Together you can determine if you should be tested, and what lifestyle changes would reduce your risk.