What is Diabetes?

Diabetes is a chronic health condition that is characterized by high blood glucose levels. Under normal conditions, the body uses sugar (glucose) to produce energy that is required to perform essential and daily functions.

Sugar is mainly obtained from a variety of food sources such as bread, fruits, starchy vegetables, and milk. To convert sugar into energy, it is the responsibility of a hormone known as insulin that acts as a key by helping sugar particles pass from the blood into the cell. Insulin is produced by the pancreas, a gland that is located underneath the liver and behind the stomach. When the pancreas is unable to produce insulin, produces it in smaller amounts (not enough for the body’s needs), or the body is not responding well to the insulin’s action (a phenomenon known as insulin resistance), this leads to diabetes.

As a result, the sugar cannot be used by the body and remains in the blood in high levels which is known as “hyperglycemia”.

Types of Diabetes

Type 1 Diabetes

This type is more common in children but can occur at any age; it is not caused by weight gain or eating large amounts of sugar. In this case, the insulin is completely deficient because the pancreas is not able to produce it. It is believed that the immune cells, particularly lymphocytes, attack the pancreas and destroy all cells that are responsible of secreting insulin. Consequently, the sugar accumulates in the blood and cannot reach cells to produce energy; this leads to high blood sugar levels and the appearance of diabetes symptoms.

Type 1 diabetes is mainly caused by genetic and immunologic factors that CANNOT be prevented. It accounts for 10% only of all diabetes cases.

Type 2 Diabetes

Gestational Diabetes

Maturity Onset Diabetes of the Young (MODY)

Symptoms of Diabetes

Diagnosing diabetes is commonly made by coincidence because many people cannot feel any of these symptoms. Regular medical checkups are essential for those who are at risk of developing diabetes to prevent any late detection of the condition.

Most common symptoms to look out for include:

  • Frequent urination
  • Frequent thirst
  • Frequent hunger
  • Impaired vision
  • Unexplained weight loss (especially in children)
  • Extreme tiredness
  • Urinary and genital infections
  • Wounds that won’t heal

Specific symptoms in type 1 diabetes

Causes of Diabetes

Type 1 Diabetes

This type is mainly caused by genetic and immunologic factors that CANNOT be prevented. It accounts for 10% only of all diabetes cases.

Type 2 Diabetes

Diabetes Complications

Diabetes complications can be divided into:

Acute complications

  • Low blood glucose levels (hypoglycemia) in both type 1 and 2 diabetes,
  • Diabetes ketoacidosis when blood sugar levels are extremely high

These complications can be prevented by regular monitoring of blood sugar and compliance to the treatment plan.

Long-term diabetes complications


There are three lab test results that are required for a proper diagnosis by the physician:

Lab TestNormalPre-diabetesDiabetes
Fasting glucoseLess than 5.6 mmol/L
(< 100 mg/dL)
5.6 – 6.9 mmol/L
(100 – 125 mg/dL)
7 mmol/L or greater
(≥ 126 mg/dL)
2 hours after mealLess than 7.8 mmol/L
(<140 mg/dL)
7.8 – 11 mmol/L
(140 – 199 mg/dL)
11.1 mmol/L or greater
(≥ 200 mg/dL)
HbA1cLess that 5.7%5.7 – 6.4%6.5% or greater


Type 1 Diabetes

Until this day, this type cannot be cured or prevented. People with type 1 diabetes need injectable insulin therapy for survival. There are some medical centers that offer pancreatic transplant for those who have severe diabetes complications, such as kidney failure or recurrent low blood sugar (hypoglycemia).

Type 2 Diabetes

Glucose-Lowering Agents

It is highly recommended for people with type 2 diabetes to eat healthy and to exercise regularly (lifestyle modification approach). However, if blood sugar levels are not controlled by this approach, the treating doctor may consider diabetes medications that are commonly used to manage this condition. These medications are classified into different groups according to their unique action and how they work to help keep blood sugar levels under control. The medications also differ in the way they are administered; some can be taken orally in tablet form whilst others can be injected.

Selection of medication for treating type 2 diabetes

Depending on the patient’s medical history, the treating doctor may prescribe one glucose-lowering agent or more to help manage blood sugar levels appropriately. Usually, metformin (from the biguanide class of medications) is the first choice for people with type 2 diabetes, in addition to lifestyle modification. If metformin alone is not effective in controlling blood sugar levels, another medication can be given as an alternative or in addition to metformin. The type of medication the doctor selects depends on many factors, examples of which are:

  • Risks and benefits of medication selected
  • If the medication causes weight gain or weight reduction
  • Other health conditions the patient has
  • Other medications the patient takes (drug interactions)
  • If patient accepts injections
  • Cost of medication

Glucose-lowering agents do not cure diabetes; they may work together to keep the condition under control. People with type 2 diabetes may need to take multiple medications that work in different ways to reduce high glucose levels. For more information about the different medication groups, below is a summary of the agents belonging to each category:


Insulin Secretagogues

DPP-4 Inhibitors

GLP-1 Analogues

SGLT2 Inhibitors


Prediabetes is an intermediate silent stage between normal and type 2 diabetes. Blood sugar levels in this stage are above normal but not high enough to meet diabetes diagnostic standards. Statistics show that 84% of people who are not aware of their blood glucose are at higher risk to develop type 2 diabetes, heart disease, or stroke.

It is good to know that prediabetes is a reversible stage (preventable). Following a healthy lifestyle can bring high sugar values back to normal and thus prevent or delay the progression to type 2 diabetes and other complications.

Prediabetes Causes

Insulin is a hormone secreted from the pancreas to regulate high blood sugar levels. Think about insulin like a key that opens the cell’s gate for sugar molecules to enter the cell to produce energy. In prediabetes, the cells cannot respond well to the action of insulin (a phenomenon known as insulin resistance). Hence, the blood sugar levels start to rise. Consequently, the pancreas tries to compensate by producing more insulin and eventually becomes exhausted. Insulin production rate decreases and becomes insufficient to meet the body’s needs. The blood sugar levels in this case continue to rise. If high blood sugar levels are not controlled at this stage, the decline in insulin levels continues in its path to type 2 diabetes.

Risk Factors

Signs and Symptoms

Prediabetes and Diabetes Diagnostic Criteria

Our Advice

There are some basic actions that should be taken by all people with diabetes, whether type 1 or 2, to maintain good health and to prevent/delay diabetes-related complications. These actions may include:

  • Follow a healthy and balanced diet
  • Regular physical activity, preferably on daily basis for at least 30 minutes. Exercise improves insulin resistance which helps in maintaining normal blood glucose levels
  • Quit smoking
  • Regular blood sugar monitoring, especially for insulin users
  • Medication and insulin compliance as directed by the treating doctor
  • Regular follow up with the treating doctor and medical tests

Type 1 diabetes cannot be prevented but it is possible to prevent or delay type 2 diabetes by following a healthy lifestyle that includes:

  • Increasing physical activity
  • Eating healthy food
  • Quitting smoking
  • Maintaining healthy weight

Diabetes and Driving: All people treated with insulin injections or medications that stimulate the pancreas should closely monitor their blood sugar levels before driving their vehicles. This is extremely important, as it can prevent hypoglycemia while driving. Hypoglycemia can be life-threatening if it occurs on the road and may cause serious injuries for those travelling with you, in other vehicles, and to pedestrians.

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