Health & Wellness Journal

🩸 Diabetes Mellitus: Types, Causes, Symptoms, and Blood Sugar Management

Diabetes mellitus is a group of chronic endocrine disorders in which the body cannot effectively regulate blood glucose levels. According to the International Diabetes Federation, more than 530 million adults worldwide are living with diabetes, and this number continues to grow. The disease affects virtually every organ and system, and without proper management, it can lead to severe complications that significantly reduce quality of life and life expectancy.

The Role of Insulin and How the Disease Develops

Glucose is the primary source of energy for the body’s cells. For glucose to move from the blood into a cell, the hormone insulin, which is produced by the beta cells of the pancreas, is required. Insulin acts like a “key”: it binds to receptors on the cell surface and opens channels that allow glucose to enter.

In diabetes, this mechanism is disrupted: either the pancreas does not produce enough insulin, or the body’s cells stop responding to it properly. As a result, glucose builds up in the blood while cells are deprived of energy. Chronically elevated blood sugar damages blood vessels, nerve fibers, and internal organs.

Types of Diabetes

Type 1 Diabetes

Type 1 diabetes accounts for approximately 5–10% of all diabetes cases. It is an autoimmune disease in which the immune system mistakenly attacks and destroys the beta cells of the pancreas. As a result, the organ almost completely stops producing insulin. Type 1 diabetes most commonly develops during childhood or adolescence, although it can occur at any age. People with this type require daily insulin injections throughout their lives. The exact causes of the autoimmune response are not fully understood, but genetic predisposition and viral infections are believed to play a role.

Type 2 Diabetes

This is the most common type, accounting for up to 90–95% of all cases. In type 2 diabetes, the pancreas continues to produce insulin, but the body’s cells become less sensitive to it—a condition known as insulin resistance. In the early stages, the pancreas compensates by producing more insulin, but over time its capacity becomes depleted, and blood sugar levels begin to rise. Risk factors include obesity, especially visceral obesity, a sedentary lifestyle, an unhealthy diet, age over 45, a family history of diabetes, and polycystic ovary syndrome in women.

Gestational Diabetes

Gestational diabetes develops during pregnancy in women who did not previously have diabetes. Placental hormones increase insulin resistance, and if the pancreas cannot cope with the increased demand, blood sugar levels rise. In most cases, the condition resolves after childbirth. However, having had gestational diabetes significantly increases the future risk of developing type 2 diabetes for both the mother and the child.

Early Symptoms and Warning Signs

The insidious nature of type 2 diabetes lies in the fact that it may develop for years without obvious symptoms. Nevertheless, there are several signs to watch for:

  • Frequent urination (polyuria) — the kidneys attempt to remove excess glucose through the urine
  • Persistent thirst (polydipsia) — the body replaces lost fluids
  • Increased appetite accompanied by weight loss — the cells are not receiving energy
  • Chronic fatigue and weakness — a consequence of cells being deprived of energy
  • Blurred vision — high blood sugar causes the lens of the eye to swell
  • Slow healing of wounds and cuts — due to impaired blood supply to tissues
  • Numbness or tingling in the hands and feet — early signs of neuropathy
  • Frequent infections — including skin, fungal, and genitourinary infections
  • Darkened skin in body folds, such as the neck and armpits — a sign of insulin resistance

With type 1 diabetes, symptoms develop rapidly—within a few weeks—and may include nausea, vomiting, abdominal pain, and a distinctive fruity odor on the breath, which is a sign of ketoacidosis.

Long-Term Complications

Chronically elevated glucose levels damage small and large blood vessels, nerve fibers, and target organs. The main complications develop gradually, often over many years.

Diabetic Neuropathy

This is damage to the peripheral nerves and occurs in 50% of patients who have had diabetes for many years. It causes numbness, burning, tingling, and pain in the feet and hands. Over time, sensation is lost, increasing the risk of injuries and unnoticed damage.

Diabetic Retinopathy

This condition involves damage to the small blood vessels of the retina. It begins with microaneurysms and pinpoint hemorrhages and may progress to a proliferative stage involving the growth of new, fragile blood vessels and retinal detachment. It is one of the leading causes of blindness among working-age adults.

Diabetic Nephropathy

This condition involves damage to the kidney’s glomeruli, gradually reducing the kidneys’ filtering capacity. In its early stage, it presents as microalbuminuria, or protein in the urine. As it progresses, it may lead to chronic kidney failure requiring dialysis or a kidney transplant.

Diabetic Foot Syndrome

This is a complex complication involving neuropathy, impaired blood supply, and susceptibility to infections. Minor foot injuries, such as calluses, cracks, and cuts, may go unnoticed because of reduced sensation, become infected, and develop into ulcers that heal extremely poorly. In severe cases, gangrene develops and may require amputation.

In addition, diabetes significantly increases the risk of heart attack, stroke, peripheral artery disease, and cognitive impairment.

Blood Sugar Control

Regular glucose monitoring is the foundation of diabetes management. Portable blood glucose meters are used to measure sugar in a drop of blood obtained from a fingertip. Target values for most patients are 4.0–7.0 mmol/L while fasting and no more than 10.0 mmol/L two hours after a meal. Glycated hemoglobin (HbA1c) reflects the average blood sugar level over the previous 2–3 months; the target is below 7%.

Modern continuous glucose monitoring (CGM) systems measure glucose every few minutes through a sensor placed under the skin and make it possible to track trends while avoiding sharp spikes and dangerous drops.

Glycemic Index and Nutrition for Diabetes

The glycemic index (GI) indicates how quickly a food raises blood glucose levels. High-GI foods, such as white bread, sugar, mashed potatoes, and white rice, cause a sharp spike in blood sugar, while low-GI foods, such as legumes, whole grains, most vegetables, and some fruits, raise it gradually.

The basic principles of nutrition for diabetes include:

  • Base the diet on vegetables, whole grains, legumes, and lean sources of protein
  • Limit simple carbohydrates, including sugar, sweets, white bread, pastries, and sugary drinks
  • Include healthy fats, such as nuts, avocados, olive oil, and oily fish
  • Control portion sizes—even healthy foods can raise blood sugar when eaten in excess
  • Distribute carbohydrates evenly throughout the day, with 3 main meals and 1–2 snacks
  • Consume enough fiber, 25–30 grams per day, as it slows glucose absorption
  • Limit alcohol, as it can cause both high blood sugar and dangerously low blood sugar

Meal planning based on carbohydrate exchanges or carbohydrate counting helps predict how food will affect glucose levels and determine the appropriate insulin dose.

Physical Activity and Weight Management

Regular physical activity increases the cells’ sensitivity to insulin, helps control weight, and lowers blood sugar levels. At least 150 minutes of moderate aerobic exercise per week, such as brisk walking, swimming, or cycling, is recommended in combination with strength training 2–3 times per week. Even a 10-minute walk after a meal significantly reduces the postprandial rise in glucose.

Losing just 5–7% of excess body weight significantly improves type 2 diabetes management and may reduce the need for medication. In people with prediabetes, defined as a fasting blood sugar level of 5.6–6.9 mmol/L, weight loss and physical activity reduce the risk of progressing to diabetes by 58%.

Prediabetes and Prevention of Type 2 Diabetes

Prediabetes is an intermediate condition in which blood sugar is already elevated but has not yet reached diabetic levels. It represents a “window of opportunity” for preventing the disease. Approximately 70% of people with prediabetes will eventually develop type 2 diabetes if they do not take action.

Effective prevention strategies include:

  • Maintaining a healthy weight or losing weight if overweight
  • Engaging in regular physical activity for at least 30 minutes per day
  • Following a diet focused on vegetables, whole grains, and protein-rich foods
  • Quitting smoking, as it increases the risk of diabetes by 30–40%
  • Monitoring glucose levels regularly, especially when risk factors are present
  • Managing stress and getting enough sleep, 7–8 hours per night, as chronic sleep deprivation increases insulin resistance

Diabetes in Children and Adolescents

Type 1 diabetes is one of the most common chronic childhood diseases. It requires constant management, including regular insulin injections, glucose measurements, and carbohydrate counting. For children and adolescents, this is a serious challenge associated with feeling “different” from their peers and the need for self-discipline.

An alarming trend in recent decades has been the increase in type 2 diabetes among children and adolescents, driven by the childhood obesity epidemic. A sedentary lifestyle and excessive consumption of fast food and sugary drinks are the main risk factors. It is important for parents to establish healthy eating habits in their children and encourage active play and sports from an early age.

Psychological Aspects of Living with Diabetes

Diabetes is not only a physical disease. The need for constant self-monitoring, fear of complications, dietary restrictions, and social inconveniences create a significant psychological burden. People with diabetes are 2–3 times more likely to develop depression, while emotional burnout related to the disease, known as “diabetes distress,” affects one in three patients.

It is important not to remain silent about emotional difficulties and to seek help from a psychologist or support group. Family involvement, diabetes education programs, and communication with other patients help people cope with the psychological burden of the disease.

Common Myths About Diabetes

Many misconceptions surround diabetes. Some of the most common include:

  • “Eating sweets causes diabetes” — excessive sugar consumption does not cause diabetes by itself, but it can contribute to obesity, one of the key risk factors for type 2 diabetes
  • “Insulin is addictive” — insulin does not cause dependence; it is essential for people with type 1 diabetes and is prescribed for type 2 diabetes when other methods do not provide adequate control
  • “Diabetes is a death sentence” — with proper management, people with diabetes can live long, fulfilling lives
  • “People with diabetes cannot eat fruit” — most fruits are acceptable, but the carbohydrate content and glycemic index must be considered
  • “Type 2 diabetes is not serious” — the complications of type 2 diabetes are no less dangerous than those of type 1, and the disease requires ongoing attention

Diabetes mellitus is a serious but manageable disease. Early diagnosis, proper blood sugar control, healthy nutrition, physical activity, and regular monitoring by an endocrinologist can minimize the risk of complications and maintain a high quality of life for many years. If any warning symptoms appear, it is important not to delay seeing a doctor—the earlier treatment begins, the better the prognosis.

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