This post was written by Susan Murry, DNP, CNP, PPG – Family Medicine.
Diabetes mellitus, commonly known as diabetes, is a disease diagnosed by testing the level of sugar, or glucose, in the blood. A person who has fasted or not eaten or drank anything other than water for four hours and whose blood sugar is over 100 should have a hemoglobin A1c blood test done. This test provides a three-month average of blood sugars. Typically, a result of less than 5.7% is normal. Results ranging from 5.7% to 6.4% can indicate prediabetes, and anything over 6.4% may indicate that someone has diabetes.
The ins and outs of insulin
Insulin, made in the pancreas, is required to move sugar from the bloodstream into cells. It supplies the body with its primary source of energy. For example, if a person’s muscle cells do not get glucose into them, regardless of how high the blood sugar is in the bloodstream, their muscles will become weak and fatigued. Additionally, because of the amount of sugar in the blood, their kidneys must work harder to dispose of it through the urine. As a result, a person with diabetes will urinate frequently and feel very thirsty as the body attempts to rid itself of the extra glucose.
Differentiating between Type 1 and Type 2
In both types, the problem is insulin. However, in Type 1 diabetes, the body’s immune system attacks itself, and the pancreas stops making insulin. In the past, this disease was called juvenile diabetes, but the disease can occur any time from infancy to late adulthood. Moreover, Type 1 Diabetes progresses rapidly and usually gets identified in the emergency room after extreme illness with rapid weight loss, nausea and vomiting.
In Type 2 diabetes, insulin is also a problem. Instead of having no insulin, a person with Type 2 Diabetes is making plenty of insulin, especially in the early years of the disease, but the body’s cells have become resistant to it. Therefore, more insulin is needed to flood the cells, so some glucose gets to the appropriate places within the body. Furthermore, unlike Type 1, Type 2 diabetes is progressive and may take many years of abnormal insulin resistance before blood sugars rise and a person gets diagnosed with diabetes. In most cases, people with Type 2 diabetes recall feeling tired for several months and say their thirst and frequent urination symptoms have gradually gotten worse.
Causes of the condition
So, why do people develop diabetes? Let’s examine each category a little further. The risk for both Type 1 and Type 2 diabetes can be genetic. Type 1 Diabetes can occur in families with members who have the condition or other autoimmune diseases such as Rheumatoid Arthritis. However, like other autoimmune diseases, there are also individuals with no family history that present with Type 1 diabetes and have no explanation of why they suddenly developed the disease.
The genetic risk for Type 2 Diabetes is quite different from Type 1 but no less significant. Insulin resistance is often a precursor to Type 2 diabetes unless the individual with high insulin resistance follows a very low carbohydrate diet and exercises regularly. While many families have a history of Type 2 diabetes, it is preventable with weight control, a low carbohydrate diet and regular exercise, unlike Type 1 diabetes.
In the United States, only 10% of diabetics are Type 1. This number has not changed dramatically over the past 50 years. However, the total number of people with Type 2 diabetes will likely rise from 11 million in 2000 to almost 20 million by 2025. By the year 2050, the American Diabetes Association projects more than 29 million people having Type 2 diabetes, a 165% increase over the 2000 level. These projections imply a steady rise in the overall prevalence of diabetes, from 3.99% in 2000 to 7.21% in 2050. 
Considering this dramatic increase in Type 2 diabetes, the development and marketing of new treatments are everywhere. Most commercials seen on television are for Type 2 diabetes medications, but innovations in Type 1 diabetes are also underway, including improvements in the artificial pancreas and insulin pump technology.