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Diagnosis of Diabetes Web Site

Diagnosis of Diabetes PDF File

What is diabetes?

Diabetes is a disease in which levels of blood glucose, also called blood sugar, are above normal. People with diabetes have problems converting food to energy. Normally, after a meal, the body breaks food down into glucose, which the blood carries to cells throughout the body. Cells use insulin, a hormone made in the pancreas, to help them convert blood glucose into energy.

People develop diabetes because the pancreas does not make enough insulin or because the cells in the muscles, liver, and fat do not use insulin properly, or both. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Over the years, high blood glucose, also called hyperglycemia, damages nerves and blood vessels, which can lead to complications such as heart disease, stroke, kidney disease, blindness, nerve problems, gum infections, and amputation.

Main Types of Diabetes

The two main types of diabetes are called type 1 and type 2. A third form of diabetes is called gestational diabetes.

  • Type 1 diabetes, formerly called juvenile diabetes, is usually first diagnosed in children, teenagers, and young adults. In this form of diabetes, the pancreas no longer makes insulin because the body’s immune system has attacked and destroyed the pancreatic cells specialized to make insulin. These insulin-producing cells are called beta cells.

  • Type 2 diabetes, formerly called adult-onset diabetes, is the most common form. People can develop type 2 diabetes at any age, even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which muscle, liver, and fat cells do not use insulin properly. As a result, the body needs more insulin to help glucose enter cells to be used for energy. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, the pancreas loses its ability to secrete enough insulin in response to meals.

  • Gestational diabetes is diabetes that first occurs during pregnancy. When women are pregnant, their need for insulin appears to increase, and many can develop gestational diabetes during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life.

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Other Types of Diabetes

A number of other types of diabetes exist. A person may exhibit characteristics of more than one type. For example, in latent autoimmune diabetes in adults (LADA), also called type 1.5 diabetes or double diabetes, people show signs of both type 1 and type 2 diabetes. Diagnosis usually occurs after age 30.

Most people with LADA still produce their own insulin when first diagnosed, like those with type 2 diabetes, but within a few years, they must take insulin to control blood glucose levels. In LADA, as in type 1 diabetes, the beta cells of the pancreas stop making insulin because the body’s immune system attacks and destroys them. Some experts believe that LADA is a slowly developing kind of type 1 diabetes.

Other types of diabetes include those caused by

  • genetic defects of the beta cell, such as maturity-onset diabetes of the young (MODY) and neonatal diabetes mellitus
  • genetic defects in insulin action, resulting in the body’s inability to control blood glucose levels, as seen in leprechaunism and the Rabson-Mendenhall syndrome
  • diseases of the pancreas or conditions that damage the pancreas, such as pancreatitis and cystic fibrosis
  • excess amounts of certain hormones resulting from some medical conditions—such as cortisol in Cushing’s syndrome—that work against the action of insulin
  • medications that reduce insulin action, such as glucocorticoids, or chemicals that destroy beta cells
  • infections, such as congenital rubella and cytomegalovirus
  • rare autoimmune disorders, such as stiff-man syndrome, an autoimmune disease of the central nervous system
  • genetic syndromes associated with diabetes, such as Down syndrome and Prader-Willi syndrome

Type 1 and type 2 diabetes

In 1997, to move away from naming the two main types of diabetes based on treatment or the age at onset, an American Diabetes Association expert committee recommended universal adoption of simplified terminology. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) agrees.

Former Name Preferred Names
Type I

juvenile diabetes

insulin-dependent diabetes mellitus

IDDM
type 1 diabetes 
Type II
adult-onset diabetes
noninsulin-dependent diabetes mellitus

NIDDM
type 2 diabetes 

Who should be tested for diabetes and pre-diabetes?

The American Diabetes Association recommends that testing to detect pre-diabetes and type 2 diabetes be considered in adults without symptoms who are overweight or obese and have one or more additional risk factors for diabetes. In those without these risk factors, testing should begin at age 45. The Body Mass Index Table can be used to find out whether someone is normal weight, overweight, obese, or extremely obese.

People aged 45 or older should consider getting tested for pre-diabetes or diabetes. People younger than 45 should consider testing if they are overweight, obese, or extremely obese and have one or more of the following risk factors:

  • being physically inactive
  • having a parent, brother, or sister with diabetes
  • having a family background that is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander
  • giving birth to a baby weighing more than 9 pounds or being diagnosed with gestational diabetes
  • having high blood pressure—140/90 mmHg or above—or being treated for high blood pressure
  • having an HDL, or “good,” cholesterol level below 35 mg/dL or a triglyceride level above 250 mg/dL
  • having polycystic ovary syndrome, also called PCOS
  • having IFG or IGT on previous testing
  • having a condition called acanthosis nigricans, characterized by a dark, velvety rash around the neck or armpits
  • having a history of cardiovascular disease—disease affecting the heart and blood vessels

If results of testing are normal, testing should be repeated at least every 3 years. Doctors may recommend more frequent testing depending on initial results and risk status. People whose test results indicate they have pre-diabetes should have their blood glucose checked again in 1 to 2 years and take steps to prevent type 2 diabetes.

When a woman is pregnant, the doctor will assess her risk for developing gestational diabetes at her first prenatal visit and order testing as needed during the pregnancy. Women who develop gestational diabetes should also have follow-up testing 6 to 12 weeks after the baby is born.

Type 2 diabetes has become more common in children and teens than in the past, and those at high risk for developing diabetes should be tested every 2 years. Testing should begin at age 10 or at puberty, whichever occurs first. Children and teens who are overweight or obese and have other risk factors, such as a family history of diabetes, are at high risk for developing diabetes.

warning
The information in this section is not meant to diagnose your medical problem; it is for informational purposes only. Please consult your medical doctor if you have any questions about your health. All information copied with permission from

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