What are the most common types of diabetes?

Type 1 diabetes

If you have type 1 diabetes, your body does not make insulin. Your immune system attacks and destroys the cells in your pancreas that make insulin. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age. People with type 1 diabetes need to take insulin every day to stay alive.

Type 2 diabetes

If you have type 2 diabetes, your body does not make or use insulin well. You can develop type 2 diabetes at any age, even during childhood. However, this type of diabetes occurs most often in middle-aged and older people. Type 2 is the most common type of diabetes.

Gestational diabetes

Gestational diabetes develops in some women when they are pregnant. Most of the time, this type of diabetes goes away after the baby is born. However, if you’ve had gestational diabetes, you have a greater chance of developing type 2 diabetes later in life. Sometimes diabetes diagnosed during pregnancy is actually type 2 diabetes.

How common is diabetes?

South Africa has one of the highest prevalence rates of diabetes in sub-Saharan Africa. The International Diabetes Federation estimates that there are approximately 4.6 million South African adults with diabetes, about half of whom remain undiagnosed.

Who is more likely to develop type 2 diabetes?

You are more likely to develop type 2 diabetes if you are age 45 or older, have a family history of diabetes, or are overweight. Physical inactivity and certain health problems such as high blood pressure also affect your chance of developing type 2 diabetes. You are also more likely to develop type 2 diabetes if you have prediabetes or had gestational diabetes when you were pregnant. Learn more about risk factors for type 2 diabetes.

What health problems can people with diabetes develop?

Over time, high blood glucose leads to problems such as:

• Heart disease
• Stroke
• Kidney disease
• Eye problems
• Dental disease
• Nerve damage
• Foot problems

Symptoms of diabetes include:

• Increased thirst and urination
• Increased hunger
• Fatigue
• Blurred vision
• Numbness or tingling in the feet or hands
• Sores that do not heal
• Unexplained weight loss

• Achieve and maintain a healthy body weight
• Be physically active – doing at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control
• A diabetes diet simply means eating the healthiest foods in moderate amounts and sticking to regular meal times. A diabetes diet is a healthy-eating plan that's naturally rich in nutrients and low in fat and calories. Key elements are fruits, vegetables and whole grains, avoiding sugar and saturated fats
• Avoid tobacco use – smoking increases the risk of diabetes and cardiovascular disease

Diagnosis and treatment

Early diagnosis can be accomplished through relatively inexpensive testing of blood sugar. Here are ten questions to ask if you are worried you have diabetes.

Treatment of diabetes involves diet and physical activity along with lowering of blood glucose and the levels of other known risk factors that damage blood vessels. Ending tobacco use is also important to avoid complications.

Interventions that are both cost-saving and feasible in low- and middle-income countries include:

• Blood glucose control, particularly in type 1 diabetes. People with type 1 diabetes require insulin, people with type 2 diabetes can be treated with oral medication, but may also require insulin
• Blood pressure control
• Foot care - patient self-care by maintaining foot hygiene, wearing appropriate footwear, seeking professional care for ulcer management and regular examination of feet by health professionals

Other cost-saving interventions include:

• Screening and treatment for retinopathy (which causes blindness)
• Blood lipid control (to regulate cholesterol levels)
• Screening for early signs of diabetes - related kidney disease and treatment

Diagnosis of Diabetes

• Fasting plasma glucose (FPG) test:
  The FPG blood test measures your blood glucose level at a single point in time. For the most reliable results, it is best to have this test in the morning, after you fast for at least 8 hours. Fasting means having nothing to eat or drink except sips of water.
• A1C test:
  The A1C test is a blood test that provides your average levels of blood glucose over the past 3 months. Other names for the A1C test are haemoglobin A1C, HbA1C, glycated hemoglobin, and glycosylated hemoglobin test. You can eat and drink before this test. When it comes to using the A1C to diagnose diabetes, your doctor will consider factors such as your age and whether you have anemia NIH external link or another problem with your blood. The A1C test is not accurate in people with anemia.
  • If you’re of African, Mediterranean, or Southeast Asian descent, your A1C test results may be falsely high or low. Your health care professional may need to order a different type of A1C test.
  • Your health care professional will report your A1C test result as a percentage, such as an A1C of 7 percent. The higher the percentage, the higher your average blood glucose levels.
  • People with diabetes also use information from the A1C test to help manage their diabetes.

Complications

Long-term complications of diabetes develop gradually. The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Possible complications include:

• Cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you're more likely to have heart disease or stroke.
• Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.

Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.

• Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.

• Eye damage (retinopathy). Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.

• Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.

• Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.

• Hearing impairment. Hearing problems are more common in people with diabetes.

• Alzheimer's disease. Type 2 diabetes may increase the risk of dementia, such as Alzheimer's disease. The poorer your blood sugar control, the greater the risk appears to be. Although there are theories as to how these disorders might be connected, none has yet been proved.

• Depression. Symptoms are common in people with type 1 and type 2 diabetes. Depression can affect diabetes management.

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