About 30 million Americans have diabetes, including about 1.25 million with type 1 diabetes and about 8 million who are undiagnosed.  In 2012, diabetes was the 7th leading cause of death in the U.S. causing nearly 70,000 deaths and contributing to nearly a quarter million. 
Diabetes is an immune-mediated metabolic disorder that causes high blood sugar levels. In a healthy person, the organs of the digestive tract break down carbohydrates and turn them into glucose, or “blood sugar.” When combined with insulin, a hormone produced by the pancreas, cells can use glucose for energy. People with diabetes either do not produce enough insulin, or are unable to use insulin properly, or both.
When insulin isn’t available, excess glucose builds up in the blood instead of being used by the cells that need energy. Over time, high blood sugar levels can damage blood vessels and nerves, eventually causing serious medical complications throughout the body.
Diabetes can be divided into two primary types – type I and type II. Type I diabetes is an autoimmune disease that develops when the immune system attacks special cells in the pancreas called beta cells which play a critical role in the production of insulin.
Type I almost always begins in childhood or young adulthood, although a latent type that occurs in people over age 30 is becoming more prevalent. Type II almost always develops later in life, usually in people who are obese, although a spike in childhood obesity has caused an increase in type II among children in recent years. A third type, gestational diabetes, occurs in pregnancy.
The underlying process that triggers diabetes hasn’t been identified, but research suggests genes and environmental factors combine to cause the disease.
Type II diabetes has specific risk factors. In addition to obesity and family history, these risk factors include :
- age 45 or older
- sedentary lifestyle
- history of gestational diabetes
- high blood pressure
- high cholesterol
- history of cardiovascular disease
- history of polycystic ovary syndrome
WHAT ARE THE SYMPTOMS?
- Symptoms for type I and type II diabetes are similar and include:
- Frequent urination
- Frequent and significant thirst
- Feeling hungry even while eating or right after eating
- Feeling very tired
- Vision problems, including blurry vision
- Inability to turn the head without pain
- Slow-healing cuts and sores
In addition, type I diabetes can cause weight loss without dieting; type II can cause tingling, sharp pain or numbness in feet or hands due to nerve damage from unmanaged blood sugar levels. 
If diabetes is not properly managed, over time it can cause serious complications including kidney disease, loss of vision and blindness, gum disease and tooth loss, cardiovascular disease, nerve damage and loss of limbs. People with diabetes are also at an increased risk for developing infections. 
Both type I and type II diabetes require patients to monitor their blood sugar levels on a regular basis – from several times a week to several times a day – to ensure levels remain within a healthy target range. When blood sugar levels become too low or too high, serious life-threatening complications can occur. To keep blood sugar levels within the target range, patients with type I diabetes also require regular injections of insulin as well as carbohydrate counting. Type II patients may also require insulin injections or other types of medications to manage their disease. Some patients with mild type II diabetes will not need insulin.
Aside from insulin, other medications used to manage diabetes include drugs to stimulate the pancreas to release additional insulin. Still other medications reduce the production and release of glucose from the liver, increase the body’s sensitivity to insulin or inhibit the kidneys’ ability to reabsorb glucose.
People with type I who have severe symptoms or extreme difficulty managing their blood sugar levels may be candidates for pancreas transplantation to eliminate the need for insulin injections. However, a pancreas transplant requires lifelong use of immune-suppressing drugs which can have serious side effects including an increased risk for cancer. Pancreas transplants are often reserved for patients who also require kidney transplant surgery.
In addition to medical treatment, lifestyle choices including a healthy diet, weight control and regular exercise are important for managing both types of diabetes. Although there is no “diabetes diet,” learning to balance food choices to help regulate blood sugar can be challenging, and many people with diabetes choose to work closely with a dietitian to ensure optimal nutrition. Regular exercise can also help manage blood sugar and insulin levels, but people with diabetes – especially those with type I and those with type II on insulin therapy – will need to check their blood sugar levels to ensure exercise hasn’t caused their blood sugar levels to drop too far.