Diabetes Mellitus

• Type 1 Diabetes: An autoimmune condition where the body's immune system attacks and destroys the insulin-producing beta cells in the pancreas. It typically develops in childhood or adolescence but can occur at any age. People with Type 1 diabetes require daily insulin injections to survive.
• Type 2 Diabetes: The most common type, occurring when the body either doesn't produce enough insulin or doesn't use insulin effectively (insulin resistance). It is often linked to genetics, lifestyle factors such as obesity and physical inactivity, and typically develops in adults, though it's increasingly seen in younger individuals.
• Gestational Diabetes: Develops during pregnancy in women who haven't previously had diabetes. It usually resolves after childbirth but increases the mother's and child's risk of developing Type 2 diabetes later in life.

Causes

• Type 1 Diabetes:
  • Autoimmune Reaction: The immune system mistakenly attacks and destroys pancreatic beta cells.
  • Genetics: A family history of Type 1 diabetes increases risk.
  • Environmental Factors: Possible viral infections or other environmental triggers may play a role.
• Type 2 Diabetes:
  • Insulin Resistance: Cells in muscles, fat, and liver become resistant to insulin, so they don't absorb enough glucose.
  • Insufficient Insulin Production: The pancreas cannot produce enough insulin to overcome resistance.
  • Genetics: Strong family history component.
  • Obesity and Overweight: A major risk factor; excess fat tissue can lead to insulin resistance.
  • Physical Inactivity: Lack of exercise contributes to insulin resistance and weight gain.
  • Age: Risk increases with age, especially after 45.
  • Ethnicity: Certain ethnic groups have a higher risk.
  • Polycystic Ovary Syndrome (PCOS): Increases insulin resistance in women.
• Gestational Diabetes:
  • Hormonal Changes During Pregnancy: Placental hormones can make cells more resistant to insulin.
  • Genetic Predisposition: Family history of diabetes.
  • Obesity before Pregnancy.
  • Previous Gestational Diabetes.

Symptoms

• Increased Thirst (Polydipsia).
• Frequent Urination (Polyuria).
• Increased Hunger (Polyphagia).
• Unexplained Weight Loss: More common in Type 1.
• Fatigue.
• Blurred Vision.
• Slow-Healing Sores.
• Frequent Infections: Such as gum, skin, or vaginal infections.
• Numbness or Tingling: In the hands or feet (peripheral neuropathy).
• Dry Skin.
• Irritability or Mood Changes.

Diagnosis

• Fasting Plasma Glucose (FPG) Test: Measures blood glucose after an overnight fast (at least 8 hours).
  • Normal: Less than 100 mg/dL (5.6 mmol/L)
  • Prediabetes: 100 to 125 mg/dL (5.6 to 6.9 mmol/L)
  • Diabetes: 126 mg/dL (7.0 mmol/L) or higher on two separate tests
• Oral Glucose Tolerance Test (OGTT): Measures blood glucose before and 2 hours after drinking a glucose-containing beverage.
  • Normal: Less than 140 mg/dL (7.8 mmol/L) after 2 hours
  • Prediabetes: 140 to 199 mg/dL (7.8 to 11.0 mmol/L) after 2 hours
  • Diabetes: 200 mg/dL (11.1 mmol/L) or higher after 2 hours
• Random Plasma Glucose Test: Measures blood glucose at any time, regardless of when you last ate.
  • Diabetes: 200 mg/dL (11.1 mmol/L) or higher, along with symptoms of diabetes.
• A1C Test (Glycated Hemoglobin Test): Measures your average blood sugar level over the past 2-3 months.
  • Normal: Below 5.7%
  • Prediabetes: 5.7% to 6.4%
  • Diabetes: 6.5% or higher on two separate tests
• Antibody Tests: For Type 1 diabetes, blood tests can detect autoantibodies that are present in Type 1 but not typically in Type 2.

Treatment

• For All Types of Diabetes:
  • Healthy Eating: Emphasize fruits, vegetables, whole grains; limit processed foods, sugary drinks, and unhealthy fats. Carbohydrate counting may be used.
  • Regular Physical Activity: At least 150 minutes of moderate-intensity aerobic activity per week, plus strength training.
  • Weight Management: Especially for Type 2 diabetes, even modest weight loss can significantly improve blood glucose control.
  • Blood Glucose Monitoring: Regular self-monitoring (SMBG) or continuous glucose monitoring (CGM) to track levels and adjust treatment.
  • Regular Check-ups: With healthcare providers, including ophthalmologists, podiatrists, and nephrologists, to monitor for complications.
• Specific Treatments by Type:
  • Type 1 Diabetes:
    • Insulin Therapy: All individuals with Type 1 diabetes require lifelong insulin replacement, administered via injections (syringes, pens) or an insulin pump. Different types of insulin (rapid-acting, short-acting, intermediate-acting, long-acting) are used.
  • Type 2 Diabetes:
    • Oral Medications:
      • Metformin: Often first-line; reduces glucose production by the liver and improves insulin sensitivity.
      • Sulfonylureas: Stimulate the pancreas to produce more insulin.
      • DPP-4 Inhibitors: Improve insulin secretion and reduce glucagon.
      • SGLT2 Inhibitors: Cause the kidneys to excrete more glucose in the urine.
      • GLP-1 Receptor Agonists: Injectable medications that slow digestion, reduce glucose production, and stimulate insulin release.
    • Injectable Non-Insulin Medications: (e.g., GLP-1 receptor agonists).
    • Insulin Therapy: May be required if oral medications and lifestyle changes are not sufficient to control blood glucose.
  • Gestational Diabetes:
    • Diet and Exercise: Often the first approach.
    • Blood Glucose Monitoring: Frequent monitoring is essential.
    • Medication: Insulin or oral medications (e.g., metformin) may be prescribed if blood glucose targets are not met with lifestyle changes.

Living With Diabetes Day to Day

The diagnosis is only the start. What determines how diabetes goes over the following decades is a small set of numbers checked on a schedule, a medication plan chosen for the organs it protects rather than the sugar alone, and a few habits that matter more in Florida than elsewhere.

The targets and the checks that go with them

For most adults the A1C goal is below 7 percent, relaxed to 7.5 or 8 for older people or those with several other conditions, where the harm of low blood sugar outweighs the benefit of tight control. A1C is checked every three months until stable and every six months after. Alongside it, once a year: urine albumin and eGFR for the kidneys, a lipid panel, and a dilated eye exam. Feet are examined at every visit. Our guide to understanding A1C explains what the number does and does not tell you, and the diabetic retinopathy and chronic kidney disease pages cover the two complications those checks are designed to catch early.

Medications are now chosen for what else they protect

Metformin remains the usual starting drug, but current guidance selects the next medication by what else the patient has. An SGLT2 inhibitor such as empagliflozin is preferred when heart failure or kidney disease is present, because it protects both regardless of its effect on glucose. A GLP-1 receptor agonist such as semaglutide is preferred when weight or cardiovascular disease is the priority. Choosing by sugar-lowering power alone is out of date.

Low blood sugar and the drugs that cause it

Hypoglycemia comes almost entirely from insulin and sulfonylureas such as glipizide; metformin, SGLT2 inhibitors, and GLP-1 agonists rarely cause it on their own. Anyone on insulin or a sulfonylurea should know the 15-15 rule (15 grams of fast carbohydrate, recheck in 15 minutes) and should have glucagon available if they live alone or have had a severe episode.

Feet, heat, and Florida

Numbness from diabetic neuropathy means a blister or a burn from hot sand goes unnoticed, and summer is when foot ulcers start. Daily foot checks, closed shoes on the beach, and never walking barefoot are covered in our diabetic foot care guide. Heat also dehydrates, which raises blood sugar, and insulin left in a hot car loses potency; the managing diabetes in Florida heat article covers both.

Remission is possible for some people with type 2

In one large trial, nearly half of people with type 2 diabetes of less than six years' duration reached remission at one year through a structured weight-loss program, and remission is now formally defined as an A1C below 6.5 percent for at least three months off glucose-lowering medication. Substantial weight loss, whether from diet, a GLP-1 agonist, or bariatric surgery, is the route, and the earlier it happens after diagnosis the more likely it is to work. The NIDDK and the CDC publish detailed patient guidance on daily management.

If your A1C has not been checked in six months, or your medication plan has not been revisited since diagnosis, schedule a visit.