Diabetes 

• An autoimmune condition: the immune system mistakenly destroys the insulin-producing beta cells in the pancreas.

• People with Type 1 produce little or no insulin.

• Usually diagnosed in children, teens, or young adults, but it can occur at any age.

• Insulin is required lifelong (via injections or an insulin pump).

• Symptoms may appear suddenly: increased thirst, frequent urination, weight loss, fatigue.

• The most common form.

• The body still makes insulin but does not use it effectively (insulin resistance), and insulin production gradually declines.

• Strongly related to genetics, lifestyle factors, weight, and metabolic health.

• Often develops gradually over years.

• Treatments include:

  • Lifestyle changes (nutrition, exercise, sleep)

  • Oral medications (e.g., metformin, others)

  • Non-insulin injectable medications (GLP-1)

  • Insulin, if needed over time

Type 2 diabetes can often be improved and sometimes put into remission, with consistent lifestyle changes.

• A slow-progressing autoimmune diabetes.

• Diagnosed in adults who initially appear to have Type 2 diabetes.

• The body gradually loses the ability to make insulin.

• Patients may respond to oral medications for a short period, but eventually most require insulin.

• Important because early recognition can prevent treatment delays.

Develops during pregnancy due to hormonal changes causing insulin resistance.

Typically appears in the second or third trimester.

Usually resolves after childbirth, but it increases the mother’s future risk of Type 2 diabetes.

Treatment focuses on:

• Healthy nutrition

• Blood sugar monitoring

• Sometimes insulin if needed

Some medications can raise blood sugar or reduce insulin sensitivity. Examples include:

• Steroids (prednisone)

• Certain antipsychotics

• Some immunosuppressive medications
  This form of diabetes may improve once the medication is adjusted or discontinued, but some people need ongoing treatment.

Diabetes can develop gradually or suddenly. Common signs include:

• Increased thirst

• Frequent urination

• Increased hunger

• Unexplained weight loss

• Fatigue or low energy

• Blurred vision

• Slow-healing wounds

• Tingling or numbness in hands or feet

• Frequent infections (skin, gums, urinary tract)

Some people have no symptoms at all, especially in early Type 2 diabetes.

Hyperglycemia (High Blood Sugar)

When blood sugar is too high, symptoms may include:

• Increased thirst

• Frequent urination

• Blurry vision

• Dry mouth

• Fatigue

• Headache

• Nausea

If blood sugar becomes very high, more serious symptoms may appear:

• Abdominal pain

• Vomiting

• Rapid breathing

• Fruity odor on breath

• Confusion

This requires urgent medical attention, especially in Type 1 diabetes (risk of diabetic keto-acidosis or DKA).

Hypoglycemia (Low Blood Sugar)

More common in people using insulin or medications that increase insulin release.

Mild to moderate symptoms:

• Shakiness

• Sweating

• Feeling hungry

• Fast heartbeat

• Irritability or anxiety

• Pale skin

• Dizziness or lightheadedness

• Difficulty concentrating

Severe symptoms:

• Confusion or behavior changes

• Slurred speech

• Loss of coordination

• Seizure

• Loss of consciousness

Always treat hypoglycemia immediately with fast-acting sugar (glucose tablets, juice, regular soda), then recheck blood sugar.

A. Oral Medications (Pills)

• Work in different ways: improving insulin sensitivity, helping t

• he body release insulin, or lowering sugar absorption from the gut or increasing glucose excretion in the urine.

• Common early treatment in Type 2 diabetes.

B. Non-Insulin Injectable Medications (GLP-1)

• Help with blood sugar control and often promote weight loss.

• Improve insulin response and reduce glucose production.

C. Insulin

Required for:

• Type 1 diabetes

• LADA (eventually)

• Gestational diabetes, when other approaches are insufficient

• Type 2 diabetes when oral and non-insulin medications are no longer enough

Insulin replaces what the body cannot produce or use properly.

A1C reflects your average blood sugar over 3 months.

• For most adults, a typical target is: A1C < 7%

• The goal may be slightly lower (e.g., < 6.5%) for some patients or 

• Higher (7–8%) for older adults or those with other medical conditions.

Always individualize goals with your physician or other healthcare practitioners.

I. Microvascular Complications (Small Blood Vessels)

A. Eye Disease (Diabetic Retinopathy)

• Can cause vision loss or blindness.

B. Kidney Disease (Diabetic Nephropathy)

• May progress to chronic kidney disease or dialysis.

C. Nerve Damage (Diabetic Neuropathy)

• Tingling, burning, numbness in feet and hands.

• Increases risk for ulcers and infections.

II. Macrovascular Complications (Large Blood Vessels)

A. Heart Disease

• Higher risk for heart attacks.

B. Stroke

• Increased risk due to effects on blood vessels.

C. Peripheral Artery Disease

• Poor circulation to legs and feet, sometimes leading to amputations.