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Diabetes

Diabetes (diabetes mellitus) is a chronic metabolic disorder characterized by elevated blood glucose levels due to defects in insulin production, insulin action, or both.

Types of Diabetes​

Type 1 Diabetes​

  • Cause: Autoimmune destruction of insulin-producing beta cells in the pancreas
  • Onset: Usually childhood or adolescence, but can occur at any age
  • Prevalence: 5-10% of all diabetes cases
  • Treatment: Requires lifelong insulin therapy
  • Associated conditions: Often occurs with other autoimmune diseases (celiac disease, thyroiditis, vitiligo)

Type 2 Diabetes​

  • Cause: Insulin resistance combined with relative insulin deficiency
  • Onset: Typically adults over 45, but increasingly seen in younger populations
  • Prevalence: 90-95% of all diabetes cases
  • Risk factors: Obesity, sedentary lifestyle, family history, certain ethnicities
  • Treatment: Lifestyle modification, oral medications, sometimes insulin
  • Reversibility: Can be reversed or put into remission with significant weight loss and lifestyle changes

Gestational Diabetes​

  • Cause: Hormonal changes during pregnancy causing insulin resistance
  • Onset: During pregnancy (usually 24-28 weeks)
  • Resolution: Usually resolves after delivery
  • Risk: 50% risk of developing Type 2 diabetes within 10 years
  • Management: Diet, exercise, sometimes insulin during pregnancy

Prediabetes​

  • Definition: Blood glucose levels higher than normal but not yet diabetic
  • Fasting glucose: 100-125 mg/dL (normal: <100 mg/dL, diabetic: ≥126 mg/dL)
  • Significance: Early warning signal of insulin resistance
  • Reversibility: Can be reversed through lifestyle interventions
  • Progression: 5-10% annual risk of developing Type 2 diabetes

Symptoms​

Early Warning Signs​

  • Increased thirst (polydipsia)
  • Frequent urination (polyuria)
  • Increased hunger (polyphagia)
  • Unexplained weight loss
  • Fatigue and weakness
  • Blurred vision
  • Slow-healing wounds
  • Frequent infections

Advanced Symptoms​

  • Numbness or tingling in hands/feet (neuropathy)
  • Darkened skin patches (acanthosis nigricans)
  • Recurrent yeast infections
  • Erectile dysfunction

Diagnosis​

Blood Tests​

Fasting Plasma Glucose (FPG):

  • Normal: <100 mg/dL
  • Prediabetes: 100-125 mg/dL
  • Diabetes: ≥126 mg/dL (on two separate occasions)

HbA1c (Glycated Hemoglobin):

  • Normal: <5.7%
  • Prediabetes: 5.7-6.4%
  • Diabetes: ≥6.5%
  • Reflects average blood glucose over past 2-3 months

Oral Glucose Tolerance Test (OGTT):

  • 2-hour value after 75g glucose load
  • Normal: <140 mg/dL
  • Prediabetes: 140-199 mg/dL
  • Diabetes: ≥200 mg/dL

Random Plasma Glucose:

  • Diabetes: ≥200 mg/dL with classic symptoms

Monitoring​

Self-Monitoring​

  • Blood Glucose Meters: Traditional finger-prick testing - See Blood Glucose Meters & Test Strips
  • Continuous Glucose Monitors (CGM): Sensor-based 24/7 monitoring
    • FreeStyle Libre, Dexcom, Guardian
    • Real-time glucose trends and alerts
    • Valuable for Type 1 diabetes and insulin-dependent Type 2

Target Ranges​

  • Fasting/before meals: 80-130 mg/dL
  • 2 hours after meals: <180 mg/dL
  • HbA1c: <7% for most adults (individualized based on age, complications)

Treatment​

Type 1 Diabetes​

Insulin Therapy (required):

  • Basal insulin: Long-acting (once or twice daily)
  • Bolus insulin: Rapid-acting (with meals)
  • Insulin pump therapy
  • Carbohydrate counting for dose calculation

Type 2 Diabetes​

Lifestyle Interventions:

  • Weight loss (7-10% body weight)
  • Regular physical activity (150 min/week moderate exercise)
  • Mediterranean or low-carbohydrate diet
  • Structured meal timing (see Eating Routine)

Oral Medications:

  • Metformin: First-line therapy, reduces hepatic glucose production
  • SGLT2 inhibitors: Promote glucose excretion via kidneys
  • GLP-1 agonists: Enhance insulin secretion, slow gastric emptying
  • DPP-4 inhibitors: Increase incretin hormones
  • Sulfonylureas: Stimulate insulin release

Injectable Medications:

  • GLP-1 receptor agonists (semaglutide, liraglutide)
  • Insulin (when oral agents insufficient)

Complications​

Acute Complications​

Hypoglycemia (Low Blood Sugar):

  • Blood glucose <70 mg/dL
  • Symptoms: Shakiness, sweating, confusion, rapid heartbeat
  • Treatment: Fast-acting carbohydrates (glucose tablets, juice)

Hyperglycemia (High Blood Sugar):

  • Symptoms: Increased thirst, frequent urination, fatigue
  • Severe: Diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS)

Chronic Complications​

Microvascular (small blood vessels):

  • Retinopathy: Leading cause of blindness in adults
  • Nephropathy: Progressive kidney damage, may require dialysis
  • Neuropathy: Nerve damage causing pain, numbness, digestive issues

Macrovascular (large blood vessels):

  • Cardiovascular disease: 2-4x increased risk of heart attack and stroke
  • Peripheral artery disease: Poor circulation, especially in legs
  • Foot complications: Ulcers, infections, potential amputation

Other Complications:

  • Increased infection risk
  • Cognitive decline and dementia
  • Depression and anxiety
  • Dental disease
  • Skin conditions

Prevention​

Preventing Type 2 Diabetes​

  • Maintain healthy weight (BMI 18.5-24.9)
  • Regular physical activity
  • Healthy diet rich in whole grains, vegetables, lean protein
  • Limit processed foods and refined carbohydrates
  • Avoid tobacco use
  • Limit alcohol consumption

Preventing Complications​

  • Maintain target blood glucose levels
  • Control blood pressure (<140/90 mmHg)
  • Manage cholesterol (LDL <100 mg/dL)
  • Annual eye exams
  • Regular foot checks
  • Kidney function monitoring
  • Dental care
  • Vaccinations (flu, pneumonia, COVID-19)

Insulin Resistance​

Insulin resistance is a key driver of Type 2 diabetes and metabolic syndrome.

Risk Factors:

  • Visceral (abdominal) obesity
  • Sedentary lifestyle
  • High-carbohydrate diet
  • Chronic inflammation
  • Sleep deprivation
  • Stress

Metabolic Syndrome Criteria (3 of 5):

  1. Waist circumference: Men >40 inches, Women >35 inches
  2. Triglycerides ≥150 mg/dL (excess fat trapped in bloodstream)
  3. Fasting glucose ≥100 mg/dL (early warning signal)
  4. Blood pressure ≥130/85 mmHg
  5. HDL cholesterol: Men <40 mg/dL, Women <50 mg/dL

See Metabolic Syndrome for detailed criteria.

Nutrition and Diabetes​

Glycemic Control Through Diet​

  • Fiber-rich foods: Slow glucose absorption
  • Protein at breakfast: Prevents insulin spikes, see Eating Routine
  • Meal timing: Early first meal (<8:30 AM) associated with lower fasting glucose
  • Structured meals: 3 evenly spaced meals improve glycemic control vs. single daily meal

Foods to Emphasize​

  • Whole grains: Steel-cut oats, brown rice, quinoa (see Grains)
  • Vegetables: Especially bitter gourd (karela) - contains charantin and polypeptide-p that mimic insulin
  • Legumes: Lentils, chickpeas, beans - low glycemic index
  • Nuts and seeds: Improve insulin sensitivity
  • Healthy fats: Olive oil, avocados, fatty fish

Foods to Limit​

  • Refined carbohydrates: White bread, white rice, maida (refined wheat flour)
  • Sabudana (tapioca): 88% carbohydrates, causes severe glucose spikes (39+ mg/dL increases)
  • Sugary beverages: Soda, sweetened juices
  • Processed foods: High in refined sugars and unhealthy fats
  • Sugarcane juice: High glycemic load despite nutritional content

See Diet & Nutritional Analysis for detailed meal planning.

Chrononutrition and Diabetes​

Meal timing affects metabolic health independently of caloric intake:

  • Early breakfast (<8:30 AM): Lower fasting glucose, reduced HOMA-IR (insulin resistance index)
  • Delayed meal initiation: 0.6% increase in glucose and 3% increase in HOMA-IR per hour delay
  • Evening eating: Increased insulin release, disrupted circadian rhythm, higher cardiovascular risk
  • Circadian disruption: Established risk factor for Type 2 diabetes, obesity, cardiovascular disease

See Eating Routine - Chrononutrition for evidence-based meal timing strategies.

Water Intake and Glucose Control​

  • Adequate hydration: Reduces vasopressin and cortisol, improving insulin sensitivity
  • Timing considerations: Adding water to carbohydrate-heavy meals may increase initial glucose spike in diabetics (40% higher AUC in controlled diabetics)
  • Long-term benefits: Better late postprandial glucose control through improved insulin sensitivity

See Drinking Water with Meals for detailed mechanisms.

Special Populations​

PCOS and Diabetes​

  • Polycystic Ovary Syndrome (PCOS) characterized by severe insulin resistance
  • Reduced satiety hormone (CCK) secretion
  • Increased carbohydrate cravings and binge-eating behaviors
  • Requires structured meal planning, not intuitive eating alone

Celiac Disease and Type 1 Diabetes​

  • Both autoimmune conditions
  • 1-2% prevalence of celiac disease
  • Type 1 diabetes patients have higher celiac disease risk
  • Requires gluten-free diet if celiac disease present

Living with Diabetes​

Self-Care​

  • Regular blood glucose monitoring
  • Medication adherence
  • Foot care and daily inspection
  • Stress management
  • Adequate sleep (7-9 hours)
  • Support groups and education

Emergency Preparedness​

  • Carry diabetes ID card/bracelet
  • Have glucose tablets or fast-acting carbs available
  • Teach family/friends about hypoglycemia treatment
  • Sick day management plan
  • Emergency contact information

Resources and Monitoring​