Diabetes Mellitus

Signs and Symptoms

There are three main types of diabetes, including:

• Type 1 Diabetes — Aboout 5 percent to 10 percent of those with diabetes have type 1 diabetes. It's considered an autoimmune disease, meaning that the body's own immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. Patients with type 1 diabetes have very little or no insulin, and must take insulin everyday. Although the condition can appear at any age, typically type 1 diabetes is diagnosed in children and young adults, which is why it was previously called juvenile diabetes.

• Type 2 Diabetes — Accounting for 90 percent to 95 percent of those with diabetes, type 2 diabetes is the most common form of the condition. Usually, it's diagnosed in adults over age 40 and 80 percent of those with type 2 diabetes are overweight. Because of the increase in obesity, type 2 diabetes is being diagnosed at younger ages and now is frequently seen in children. Initially in type 2 diabetes, insulin is produced, but the insulin can't function properly, leading to a condition called insulin resistance. Eventually, most people with type 2 diabetes suffer from insulin resistance and decreased insulin production.

• Gestational Diabetes — Gestational diabetes develops during pregnancy. It occurs more often in African Americans, Native Americans, Latinos and people with a family history of diabetes. Typically, it disappears after delivery, although the condition is associated with an increased risk of developing diabetes later in life.

  See Diabetes in Pregnancy and Dietary Recommendations for Gestational Diabetes.

If you think that you have diabetes, visit your doctor immediately for a definite diagnosis. Common symptoms include the following:

• Frequent urination
• Excessive thirst
• Unexplained weight loss
• Extreme hunger
• Sudden vision changes
• Tingling or numbness in the hands or feet
• Feeling very tired much of the time
• Very dry skin
• Sores that are slow to heal
• More infections than usual

Some people may experience only a few symptoms that are listed above. About 50 percent of people with type 2 diabetes don't experience any symptoms and don't know they have the disease.

Learn more about our Diabetes Education Online and classes and workshops at the UCSF Diabetes Center.

Diagnosis

Your doctor will first ask about your medical history and perform a physical examination to check for symptoms of diabetes and high blood sugar. Diabetes usually is diagnosed with the following tests that measure the glucose levels in your blood:

• Fasting Plasma Glucose Test -- This is the standard test for diagnosing type 1 and type 2 diabetes. You must not eat or drink anything for at least eight hours prior to this simple test in which blood is drawn to check your sugar levels. A diagnosis of diabetes will be made if you have a fasting blood sugar level of 126 milligrams per deciliter or higher on two separate days.

• Other Tests -- Diabetes also may be diagnosed based on a random high glucose level of ³ 200mg/dl and symptoms of the disease. Your doctor may wish to perform an oral glucose tolerance test, which is the traditional test for diabetes mellitus.

Treatment

The goal of diabetes management is to keep blood glucose levels as close to normal as safely possible. In addition, since diabetes may greatly increase a person's risk for heart disease, preventative measures for tightly controlling blood pressure and cholesterol levels are now an essential part of diabetes treatment as well.

People with diabetes must take responsibility for their day-to-day care. This includes monitoring their blood glucose levels, dietary management, maintaining physical activity, keeping their weight and stress under control, monitoring their oral medications and, if required, insulin use via injections or pump. To help patients achieve this, UCSF's Diabetes Teaching Center offers self-management educational programs that emphasize individualized diabetes care. The program enables patients to make more consistent and appropriate adjustments in their therapy and lifestyle.

Dietary Management and Physical Activity

Modifying one's eating habits and increasing physical activity is typically the first step toward reducing blood sugar levels. At UCSF Medical Center, all patients work with their doctor and/or certified dietician to develop a dietary plan to manage blood sugar levels. Our Teaching Center conducts workshops that provide patients with information on food nutrient content as well as how to eat and cook in a healthier manner.

Insulin Therapy

People with type 1 diabetes require multiple insulin injections each day in order to maintain safe insulin levels. Insulin also is often required for treatment of patients with type 2 diabetes. Using an insulin pump is an alternative to injections. The pump is about the size of a pager and is usually worn on your belt. Insulin is delivered through a small tube (catheter) that is placed under the skin (usually in the abdomen).

There are four major types of insulin:

• Rapid-acting
• Short-acting
• Intermediate-acting
• Long-acting

Your doctor will determine your dose and how often you need to take insulin. There is not any standard insulin dose as it depends on many factors such as your body weight, when you eat, how often you exercise and how much insulin your body produces.

Oral Medications

Sometimes blood sugar levels remain high in people with type 2 diabetes even though they are eating in a healthy manner and exercising. When this happens, medications taken in pill form may be prescribed to help control blood sugar levels. The medications work by several different mechanisms. These include improving the effectiveness of the body's natural insulin, reducing blood sugar production, increasing insulin production and inhibiting blood sugar absorption. Oral diabetes medications are sometimes taken in combination with insulin.

Learn more about our Diabetes Education Online and classes and workshops at the UCSF Diabetes Center.