Understanding Diabetes: Types, Symptoms, and Management Strategies

Diabetes affects over 589 million adults globally and is projected to reach 853 million by 2050, making it one of the most significant health challenges of our time. This chronic condition occurs when the body cannot properly regulate blood sugar levels, leading to serious complications if left untreated.clevelandclinic+2​

What is Diabetes

Diabetes is a metabolic disorder characterized by elevated blood glucose (sugar) levels due to problems with insulin production or function. Insulin is a hormone produced by the pancreas that helps glucose enter cells to be used for energy. When this process fails, glucose accumulates in the bloodstream instead of reaching cells, causing various health complications.medicalnewstoday+1​

Global diabetes prevalence in adults has risen dramatically from 7% to 14% between 1990 and 2022, with the number of adults with diabetes surpassing 800 million worldwide—more than quadrupling since 1990. Alarmingly, about 59% of all adults with diabetes (approximately 450 million people aged 30 and older) remained untreated in 2022, with 90% of these untreated individuals living in low- and middle-income countries.who​

Types of Diabetes

Type 1 Diabetes

Type 1 diabetes (T1D) is an autoimmune condition where the immune system attacks and destroys insulin-producing beta cells in the pancreas, eliminating the body's ability to produce insulin. It typically appears in childhood or adolescence and requires lifelong insulin therapy. Symptoms develop rapidly over several weeks and include increased thirst and urination, increased hunger, blurred vision, fatigue, numbness in hands and feet, slow-healing sores, and unexplained weight loss.diabetes+1​

The exact cause of type 1 diabetes remains unknown, though family history and certain genes are linked to increased risk. T1D often develops more quickly than other types and can cause diabetic ketoacidosis (DKA), a dangerous condition that occurs when you have very high blood sugar but little or no insulin in your body.healthline+1

Type 2 Diabetes

Type 2 diabetes (T2D) is a metabolic disorder that begins with insulin resistance, meaning the body cannot use insulin efficiently. This forces the pancreas to produce more insulin until it cannot keep up with demand, after which insulin production decreases and blood sugar rises. Type 2 diabetes is mainly caused by cells in muscle, fat, and liver not responding properly to insulin, and the pancreas being unable to make enough insulin to maintain healthy blood sugar levels.mayoclinic+2​

Contributing factors include genetics, sedentary lifestyle, higher weight or obesity, age, family history, ethnicity, and waist circumference. Symptoms develop gradually over several years and may include increased thirst and urination, increased hunger, weight loss, tiredness, blurred vision, slow-healing sores, frequent infections, numbness or tingling in extremities, and darkened skin areas in the armpits and neck.mayoclinic+3​

Gestational Diabetes

Gestational diabetes mellitus (GDM) is hyperglycemia diagnosed or developing during pregnancy. Placental hormone release causes marked insulin resistance, with human placental lactogen being the primary hormone associated with this condition. In patients with GDM, pancreatic β-cell dysfunction or delayed response results in decreased insulin secretion, leading to maternal hyperglycemia.ncbi.nlm.nih​

Most pregnant people get tested for gestational diabetes at 24 to 28 weeks of pregnancy. If untreated, GDM can cause preterm birth, stillbirth, macrosomia (large baby), and neonatal hypoglycemia. However, proper glucose control significantly reduces these risks, and pregnant people with gestational diabetes can still have healthy pregnancies and babies. Early interventions reduce progression to type 2 diabetes in 10 years by 35% to 40%, and even small reductions in BMI can reduce diabetes risk by 25%.marchofdimes+1​

Common Symptoms

Diabetes symptoms are caused by rising blood sugar levels. Common symptoms across all types include increased thirst and urination, fatigue, increased hunger, blurred vision, slow-healing sores, numbness or tingling in hands or feet, and unexplained weight loss. In type 2 diabetes, symptoms develop slowly, and tingling nerves and slow-healing sores are more common.niddk.nih+2

​Serious Complications

Long-term diabetes complications can harm eyes, kidneys, nerves, skin, heart, and blood vessels. Major complications include:medlineplus​

• Cardiovascular disease: Diabetes increases risk of heart disease, stroke, high blood pressure, and atherosclerosis (narrowed blood vessels)mayoclinic​
• Nerve damage (neuropathy): High blood sugar damages nerves, causing tingling, numbness, burning, pain, or loss of feeling, most often starting in toes or fingersmayoclinic​
• Kidney disease: Diabetes may lead to chronic kidney disease or end-stage kidney disease requiring dialysis or transplantmayoclinic​
• Eye damage (retinopathy): Can lead to vision problems and blindness if untreateduspharmacist​
• Foot complications: Nerve damage and poor circulation increase infection and amputation riskuspharmacist​
• Dementia: Type 2 diabetes raises the risk of Alzheimer's disease and other forms of dementiamayoclinic​

Prevention and Management

Lifestyle Modifications

Type 2 diabetes is a preventable disease. Follow-up of large lifestyle intervention trials showed sustained diabetes prevention: 39% reduction at 30 years in the Da Qing study, 43% reduction at 7 years in the Finnish DPS, and 27% reduction at 15 years in the U.S. Diabetes Prevention Program. Losing 5-7% of body weight can reduce type 2 diabetes risk, and 150 minutes per week of moderate to vigorous physical activity (equivalent to 20 minutes daily) is recommended.diabetesjournals+1​

Multiple eating patterns effectively prevent type 2 diabetes, including Mediterranean-style, intermittent fasting, low-carbohydrate, vegetarian, plant-based, and DASH (Dietary Approaches to Stop Hypertension) diets. Emphasis should be on whole grains, legumes, nuts, fruits, vegetables, and minimal refined and processed foods.diabetesjournals​​

​Medical Management

Tighter glycemic control, management of hypertension, and lifestyle changes benefit all diabetes complications. Healthcare providers may prescribe ACE inhibitors or ARBs for high blood pressure or kidney problems, statins for cholesterol management, and aspirin to prevent heart attacks. For diabetic neuropathy pain, FDA-approved agents include pregabalin, duloxetine, and extended-release tapentadol.medlineplus+1​

Despite recent developments in newer antidiabetic medications and therapies to manage complications, the burden remains high, with continued need for more effective treatments. Pharmacists and healthcare providers should remain vigilant for signs of complications, help patients manage glycemic levels, and direct them to take appropriate preventive measures.uspharmacist​