Type 2 diabetes is the most common form, affecting about 90% of people with diabetes. It occurs when the body makes insulin but can’t use it properly. Many people with this form of diabetes can control their blood glucose levels with a program of healthy eating, exercise, and diabetes medication, although some may require insulin injections.

Gestational diabetes affects about 2% to 4% of pregnant women. It is usually a temporary condition, but having it increases a woman’s chances of developing type 2 diabetes later in life. Regular prenatal check-ups are essential, because if gestational diabetes is left untreated, it can cause serious complications for both the mother and the baby.

Who is likely to get diabetes?

There is no known way to predict who will develop type 1 diabetes. Scientific evidence suggests that people with type 1 diabetes inherit a tendency to get the condition, although it may not actually develop until some outside factor (such as a virus) triggers the person’s immune system to attack the insulin-making cells in the pancreas.

It is easier to predict who is more likely to develop type 2 diabetes, because there are specific factors that increase a person’s risk.

These include:

• age 40 or over
• being overweight, especially when excess weight is carried around the middle
• having high blood pressure or heart disease
• having a family member who has diabetes
• giving birth to a child weighing more than 4 kg (9 lbs.)
• having high levels of cholesterol or other fats in the blood
• having impaired glucose tolerance or impaired fasting glucose
• having been diagnosed with polycystic ovary syndrome, acanthosis nigricans (darkened patches of the skin), or schizophrenia
• being of Aboriginal, African, Asian, South Asian, or Hispanic descent.

What are the symptoms?

There are a number of warning signs that point to the presence of diabetes. Early detection is important because the sooner proper management begins, the less chance there is that serious complications will develop.

The warning signs to watch for include:

• extreme fatigue
• unusual thirst
• frequent urination
• unusual hunger
• unexplained weight loss or gain
• blurred vision
• frequent or recurring infections
• cuts and bruises that are slow to heal
• tingling or numbness in the hands and feet
• trouble getting or maintaining an erection

Having these warning signs does not necessarily mean a person has diabetes, and not everyone with type 2 diabetes will have symptoms, so regular medical checkups are extremely important. There are a number of tests that can be done to determine whether someone has diabetes, and testing enables a doctor to either confirm the diagnosis or rule it out and begin the search for what is causing the symptoms.

Managing Diabetes

If you have diabetes, maintaining healthy blood glucose levels is at the heart of managing your condition. There are a number of ways to do this, but you can’t control your blood glucose level if you don’t know what it is. Therefore, frequent blood glucose monitoring is crucial.

People with type 1 diabetes should measure their blood glucose at least three times daily. The frequency of testing for people with type 2 diabetes must be individualized depending on how well they are controlling their blood glucose and the type of therapy they are on. For some people with type 2 diabetes testing once a day may be enough.

In general, recommended targets for before-meal blood glucose levels range from 4.0 to 7.0 mmol/L and target blood glucose levels two hours after eating are between

5.0 and 10.0 mmol/L. However, target ranges differ somewhat from person to person, and your doctor will determine what your target blood sugar levels should be. Your diabetes educator will help you develop a plan for meeting these goals.

The main components of a diabetes management program include:

• Meal plan: A healthy meal plan is critical to managing diabetes, and the Canadian Diabetes Association offers the following guidelines:
  • Eat more vegetables.
  • Include starchy foods in every meal.
  • Make fish, lean meats, low-fat cheeses, eggs, or vegetarian protein choices part of your meal.
  • Complete your meal with a glass of milk and a piece of fruit.
  • Limit alcohol.
• Physical activity: A moderate amount of exercise on a regular basis is important for weight control, stress reduction, and overall fitness. Before beginning any exercise program, consult your doctor to make sure that what you are planning is appropriate to your age and health. Test your blood glucose level before you start your routine every time you participate. If your blood sugar is low, you may need to eat first.
• Weight management: Maintaining a healthy body weight is important for everyone with diabetes, but it is a critical part of managing type 2 diabetes.
• Stress management: Learning to reduce stress levels in your day-to-day life can help control your blood sugar level.
• Proper foot care: Foot care is especially important for people with diabetes, because the nerve damage that can result from the condition increases the risk of foot problems. Check your feet daily for blisters, cuts, bruises, or signs of infection. Wash with mild soap and warm water, and dry thoroughly, especially between your toes. Moisturize the skin on the tops and bottoms of your feet, but do not use a moisturizer between your toes. Keep your toenails trimmed straight across, not dipping down at the corners.
• Medication: Type 1 diabetes is always treated with insulin. Type 2 diabetes may require oral medicine, insulin shots, or sometimes a combination of both. It is important to follow your doctor’s instructions about when, how, and how much medication or insulin to take.