Diabetes and Prediabetes

What is diabetes?

NIDDK says diabetes happens when blood sugar is higher than it should be. Insulin is a hormone made by the pancreas that carries sugar into cells to become energy. In diabetes, either no insulin is made, too little is made, or the body does not use it well.

• Type 1: The immune system destroys the insulin-making cells. It is mostly diagnosed in children and young people, and the NHS says it can appear at any age. Its treatment is daily insulin.
• Type 2: Cells do not respond well to insulin and the pancreas falls short. NIDDK says it makes up 90 to 95 percent of cases. Overweight and family history are risk factors, and it is seen at any age.
• Gestational diabetes: It appears in pregnancy and usually goes away after delivery, but it raises the risk of type 2 diabetes in the future.
• Prediabetes: Blood sugar is higher than normal but has not yet reached the level of diabetes.

Symptoms

The NHS says the most common symptoms are tiredness, frequent urination, constant thirst and unexplained weight loss. Blurred vision, slow-healing wounds, and genital itching or yeast infection are also seen. Symptoms may appear slowly, and some people have no symptoms at all. Type 1 usually starts faster.

Who should be tested?

• NHS: Someone whose parent, brother or sister has diabetes, who is overweight and inactive, who has high blood pressure, or who is over 40. In some ethnic groups the risk is higher from age 25.
• You have the symptoms above.
• NIDDK: People with a normal result should be retested every three years, and people with prediabetes should be tested for diabetes every year.
• After gestational diabetes, check again for type 2 diabetes. NIDDK says this is usually within 12 weeks after delivery.

How is it diagnosed?

With a blood test. NIDDK lists these values:

• A1C: Below 5.7 percent is normal, 5.7 to 6.4 is prediabetes, 6.5 or higher is diabetes. Fasting is not needed.
• Fasting glucose: Fasting for at least 8 hours. Up to 99 mg/dL is normal, 100 to 125 is prediabetes, and 126 or higher is diabetes.
• Glucose tolerance test: Two hours after drinking a sugar solution, 140 to 199 is prediabetes and 200 or higher is diabetes.
• A random glucose of 200 or higher with symptoms also indicates diabetes.

A home glucose meter is not enough for diagnosis (NIDDK). The doctor usually repeats the test to confirm the diagnosis. In pregnancy the cutoffs are different. To get ready, see the guide “Preparing for lab tests”.

What does treatment look like in general?

The goal of treatment is to keep blood sugar in the target range and prevent complications. The NHS and NIDDK list these parts:

• Food and activity: A diet full of fruit, vegetables, whole grains and legumes, less processed food and less salty and sugary food, and activity that makes you breathe faster, about two and a half hours a week. The NHS warns against starting a very low-calorie diet without expert guidance, especially for people taking insulin or diabetes medicine.
• Medicine: The NHS says it usually starts with metformin and an SGLT2 medicine. If needed, a weekly injectable GLP-1 medicine or insulin is added. The doctor decides the type and plan.
• Insulin: NIDDK says it is required in type 1, and in type 2 many people come to need it over time. Sometimes it is temporary, for example in pregnancy or during a hospital stay. Insulin teaching is in the guide “Insulin, Storage and Sick Days”.
• Education: The NHS recommends diabetes education courses.

The NHS says that if you become ill, with vomiting, diarrhea or fever, contact the care team. They may adjust the medicine temporarily, but do not stop the medicine yourself.

Monitoring and follow-up

• NHS: An A1C test every three to six months. NIDDK says at least twice a year for everyone with diabetes.
• Weight, cholesterol, blood pressure and kidney function at least once a year, a foot exam every one or two years depending on the last result, and eye screening from diagnosis and then every one or two years.
• The NHS lists the complications: blood vessel damage, heart disease and stroke, foot ulcers and infection, retina damage, kidney problems and gum disease. Attending every appointment and doing every test shows them early.
• If you have blisters or cracks on the feet, pain, tingling or numbness, constipation or diarrhea, or worsening vision, tell the doctor.

Prediabetes

The CDC says prediabetes usually has no symptoms, and most people who have it do not know. With modest weight loss, healthier eating and more activity, its course can be changed. NIDDK lists a loss of 5 to 7 percent of starting weight and at least 30 minutes of activity on 5 days a week. This is not a promise of a result. Results differ for each person. See the article “What Is Prediabetes, and Can It Be Reversed?”.

Pregnancy

NIDDK says if you have diabetes and are planning a pregnancy, talk with the care team before trying. The blood sugar target, the list of medicines and supplements, and folic acid should be reviewed. If you become pregnant unexpectedly, contact the doctor as soon as possible.

When to get urgent help

• Severe low blood sugar: loss of consciousness, seizure or inability to swallow. Give nothing by mouth, lay the person on their side, give glucagon right away if you have it and know how to use it, and call 115 (Iran’s emergency number, not valid abroad).
• Low blood sugar in someone who is awake and able to swallow: take 15 to 20 grams of fast-acting sugar, such as half a cup of juice. Check again after 15 minutes and repeat if it is still low.
• Signs of ketoacidosis: thirst and frequent urination, nausea and vomiting, abdominal pain, fast and deep breathing, fruity-smelling breath, drowsiness and confusion. Call 115 or ask someone to take you to the emergency room. Do not stop insulin.
• Hyperosmolar state: thirst and frequent urination over days or weeks, weakness, confusion and seizure. Call 115 or ask someone to take you to the emergency room.

Do not drive yourself, and bring your medicines (NHS). See the full list in the guide “When should I call right away?” and how to treat a low in the guide “Checking Glucose at Home and Recognizing Low Blood Sugar”.