People with diabetes should have an individualized plan for activity and nutrition. Intensive, group-based behavioural interventions can help patients to achieve their goals. Patients should be encouraged to seek nutrition counseling from a registered dietitian; in some regions dietitian consultations are available free of charge (eg, Ontario [www.unlockfood.ca/en/default.aspx], British Columbia [www.healthlinkbc.ca/dietitian-services], and Manitoba [www.wrha.mb.ca/prog/nutrition/files/204DADStickerEnglish.pdf]).
Women seem to be at a greater risk as do certain ethnic groups,[10][109] such as South Asians, Pacific Islanders, Latinos, and Native Americans.[23] This may be due to enhanced sensitivity to a Western lifestyle in certain ethnic groups.[110] Traditionally considered a disease of adults, type 2 diabetes is increasingly diagnosed in children in parallel with rising obesity rates.[10] Type 2 diabetes is now diagnosed as frequently as type 1 diabetes in teenagers in the United States.[13]
Insulin is a hormone that is produced by specialized cells (beta cells) of the pancreas. (The pancreas is a deep-seated organ in the abdomen located behind the stomach.) In addition to helping glucose enter the cells, insulin is also important in tightly regulating the level of glucose in the blood. After a meal, the blood glucose level rises. In response to the increased glucose level, the pancreas normally releases more insulin into the bloodstream to help glucose enter the cells and lower blood glucose levels after a meal. When the blood glucose levels are lowered, the insulin release from the pancreas is turned down. It is important to note that even in the fasting state there is a low steady release of insulin than fluctuates a bit and helps to maintain a steady blood sugar level during fasting. In normal individuals, such a regulatory system helps to keep blood glucose levels in a tightly controlled range. As outlined above, in patients with diabetes, the insulin is either absent, relatively insufficient for the body's needs, or not used properly by the body. All of these factors cause elevated levels of blood glucose (hyperglycemia).
^ Jump up to: a b c d Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR (March 2015). "Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes". Diabetologia. 58 (3): 429–42. doi:10.1007/s00125-014-3460-0. PMID 25583541.
^ Cheng J, Zhang W, Zhang X, Han F, Li X, He X, Li Q, Chen J (May 2014). "Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on all-cause mortality, cardiovascular deaths, and cardiovascular events in patients with diabetes mellitus: a meta-analysis". JAMA Internal Medicine. 174 (5): 773–85. doi:10.1001/jamainternmed.2014.348. PMID 24687000.
The study, Economic Costs of Diabetes in the U.S. in 2017, was commissioned by the Association and addresses the increased financial burden, health resources used and lost productivity associated with diabetes in 2017. The study includes a detailed breakdown of costs along gender, racial and ethnic lines, and also includes a breakdown of costs on a state-by-state basis.
Diabetes Care Community is the author of articles on a wide range of diabetes topics. All of these articles are written to a high standard of quality. They are reviewed for accuracy with health care professionals and, wherever possible, will adhere to Diabetes Canada's 2018 Clinical Practice Guidelines. It is our wish that you find our articles helpful. We welcome your feedback and comments.
Two types of diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400–500 CE with one type being associated with youth and another type with being overweight.[108] The term "mellitus" or "from honey" was added by the Briton John Rolle in the late 1700s to separate the condition from diabetes insipidus, which is also associated with frequent urination.[108] Effective treatment was not developed until the early part of the 20th century, when Canadians Frederick Banting and Charles Herbert Best isolated and purified insulin in 1921 and 1922.[108] This was followed by the development of the long-acting insulin NPH in the 1940s.[108]
What are symptoms of type 2 diabetes in children? Type 2 diabetes is becoming increasingly common in children, and this is linked to a rise in obesity. However, the condition can be difficult to detect in children because it develops gradually. Symptoms, treatment, and prevention of type 2 diabetes are similar in children and adults. Learn more here. Read now
Studies have identified at least 150 DNA variations that are associated with the risk of developing type 2 diabetes. Most of these changes are common and are present both in people with diabetes and in those without. Each person has some variations that increase risk and others that reduce risk. It is the combination of these changes that helps determine a person's likelihood of developing the disease.
In adults with type 2 diabetes with clinical CVD in whom glycemic targets are not achieved with existing antihyperglycemic medication, an antihyperglycemic agent with demonstrated CV outcome benefit should be added to reduce the risk of major CV events (grade A, level IA for empagliflozin; grade A, level IA for liraglutide; grade C, level II for canagliflozin) Flow sheets:

Diabetes is one of the first diseases described[21] with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine."[112] The first described cases are believed to be of type 1 diabetes.[112] Indian physicians around the same time identified the disease and classified it as madhumeha or honey urine noting that the urine would attract ants.[112] The term "diabetes" or "to pass through" was first used in 230 BCE by the Greek Apollonius Of Memphis.[112] The disease was rare during the time of the Roman empire with Galen commenting that he had only seen two cases during his career.[112]

[1] Diabetes Prevention Program Research Group. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the Diabetes Prevention Program Outcomes Study. The Lancet Diabetes & Endocrinology. 2015;3(11):866‒875. You can find more information about this study on the Diabetes Prevention Program Outcomes Study website.
High-quality diabetes care involves a series of periodic conversations about self-management and about both pharmacologic and nonpharmacologic treatments that fit with each patient’s goals (ie, shared decision making). Incorporating these conversations into regular practice provides FPs with opportunities to maximize likely benefits of treatments and decrease the risk of harms, to support patients in initiating and sustaining desired lifestyle changes, and to help patients cope with the burdens of both diabetes and comorbid conditions. Family physicians can access the guideline at guidelines.diabetes.ca and might consider downloading the free smartphone app for quick access to guideline chapters and interactive tools at guidelines.diabetes.ca/app.

Fat distribution. If you store fat mainly in the abdomen, you have a greater risk of type 2 diabetes than if you store fat elsewhere, such as in your hips and thighs. Your risk of type 2 diabetes rises if you're a man with a waist circumference above 40 inches (101.6 centimeters) or a woman with a waist that's greater than 35 inches (88.9 centimeters).
But for most people with Type 2 diabetes not on insulin, testing is inappropriate most of the time. That message is not getting through. At the end of last year, another study was published in JAMA Internal Medicine that quantified the prevalence of glucose testing in adults. Researchers examined a database that contained data on more than 370,000 commercial health insurance and Medicare Advantage beneficiaries who had Type 2 diabetes.

Though it may be transient, untreated GDM can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital heart and central nervous system abnormalities, and skeletal muscle malformations. Increased levels of insulin in a fetus's blood may inhibit fetal surfactant production and cause infant respiratory distress syndrome. A high blood bilirubin level may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Labor induction may be indicated with decreased placental function. A caesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.[50]


^ Sattar N, Preiss D, Murray HM, Welsh P, Buckley BM, de Craen AJ, Seshasai SR, McMurray JJ, Freeman DJ, Jukema JW, Macfarlane PW, Packard CJ, Stott DJ, Westendorp RG, Shepherd J, Davis BR, Pressel SL, Marchioli R, Marfisi RM, Maggioni AP, Tavazzi L, Tognoni G, Kjekshus J, Pedersen TR, Cook TJ, Gotto AM, Clearfield MB, Downs JR, Nakamura H, Ohashi Y, Mizuno K, Ray KK, Ford I (February 2010). "Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials". Lancet. 375 (9716): 735–42. doi:10.1016/S0140-6736(09)61965-6. PMID 20167359.
People with glucose levels between normal and diabetic have impaired glucose tolerance (IGT) or insulin resistance. People with impaired glucose tolerance do not have diabetes, but are at high risk for progressing to diabetes. Each year, 1% to 5% of people whose test results show impaired glucose tolerance actually eventually develop diabetes. Weight loss and exercise may help people with impaired glucose tolerance return their glucose levels to normal. In addition, some physicians advocate the use of medications, such as metformin (Glucophage), to help prevent/delay the onset of overt diabetes.

When glucose concentration in the blood remains high over time, the kidneys reach a threshold of reabsorption, and the body excretes glucose in the urine (glycosuria).[61] This increases the osmotic pressure of the urine and inhibits reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Lost blood volume is replaced osmotically from water in body cells and other body compartments, causing dehydration and increased thirst (polydipsia).[59] In addition, intracellular glucose deficiency stimulates appetite leading to excessive food intake (polyphagia).[62]

Insulin is released into the blood by beta cells (β-cells), found in the islets of Langerhans in the pancreas, in response to rising levels of blood glucose, typically after eating. Insulin is used by about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, for conversion to other needed molecules, or for storage. Lower glucose levels result in decreased insulin release from the beta cells and in the breakdown of glycogen to glucose. This process is mainly controlled by the hormone glucagon, which acts in the opposite manner to insulin.[60]
Storage of liver fat can only occur when daily calorie intake exceeds expenditure. Sucrose overfeeding for 3 weeks has been shown to cause a 30% increase in liver fat content (37). The associated metabolic stress on hepatocytes was reflected by a simultaneous 30% rise in serum alanine aminotransferase (ALT) levels, and both liver fat and serum ALT returned to normal levels during a subsequent hypocaloric diet. Superimposed upon a positive calorie balance, the extent of portal vein hyperinsulinemia determines how rapidly conversion of excess sugars to fatty acid occurs in the liver. In groups of both obese and nonobese subjects, it was found that those with higher plasma insulin levels have markedly increased rates of hepatic de novo lipogenesis (2,38,39). Conversely, in type 1 diabetes the relatively low insulin concentration in the portal vein (as a consequence of insulin injection into subcutaneous tissue) is associated with subnormal liver fat content (40). Initiation of subcutaneous insulin therapy in type 2 diabetes brings about a decrease in portal insulin delivery by suppression of pancreatic insulin secretion and, hence, a decrease in liver fat (41). Hypocaloric diet (42), physical activity (43), or thiazolidinedione use (23,44) each reduces insulin secretion and decreases liver fat content. Newly synthesized triacylglycerol in the liver will be either oxidized, exported, or stored as hepatic triacylglycerol. Because transport of fatty acid into mitochondria for oxidation is inhibited by the malonyl-CoA produced during de novo lipogenesis, newly synthesized triacylglycerol is preferentially directed toward storage or export. Hence, hepatic fat content and plasma VLDL triacylglycerol levels are increased.
Up to 40 percent of people with type 2 diabetes eventually develop kidney failure — the kidney's inability to filter waste and fluid from the blood, according to the National Kidney Foundation. As blood flows through tiny vessels in the kidneys, waste products are filtered out and leave the body through urine. Too much sugar in the blood can stress these filters, making it hard for the kidneys to work effectively. After a while, the filters can break down and leak protein into the urine. If kidney damage continues, you may need dialysis or a kidney transplant.
Best of them all I was diagnosed LADA a year ago. Downloaded a bunch of apps and used them all for a month. This one’s easily the winner. Extremely comprehensive, a complete set of features and enough customization to track carb intake; initial no pill and no insulin treatment; then medication only treatment; then long lasting insulin treatment. And I know it’s future proof for when I start the short term insulin and then the pump. Thank you!
^ Hilawe, Esayas Haregot; Yatsuya, Hiroshi; Kawaguchi, Leo; Aoyama, Atsuko (1 September 2013). "Differences by sex in the prevalence of diabetes mellitus, impaired fasting glycaemia and impaired glucose tolerance in sub-Saharan Africa: a systematic review and meta-analysis". Bulletin of the World Health Organization. 91 (9): 671–682D. doi:10.2471/BLT.12.113415. PMID 24101783.
The risk of diabetes varies by ethnic and geographic background. In the United States, the disease is most common in Native Americans and Alaska Natives. It also has a higher prevalence among people of African American or Hispanic ancestry than those of non-Hispanic white or Asian ancestry. Geographically, diabetes is most prevalent in the southern and Appalachian regions of the United States.
In 2017, 425 million people had diabetes worldwide,[8] up from an estimated 382 million people in 2013[17] and from 108 million in 1980.[101] Accounting for the shifting age structure of the global population, the prevalence of diabetes is 8.8% among adults, nearly double the rate of 4.7% in 1980.[8] [101] Type 2 makes up about 90% of the cases.[16][18] Some data indicate rates are roughly equal in women and men,[18] but male excess in diabetes has been found in many populations with higher type 2 incidence, possibly due to sex-related differences in insulin sensitivity, consequences of obesity and regional body fat deposition, and other contributing factors such as high blood pressure, tobacco smoking, and alcohol intake.[102][103]

People with glucose levels between normal and diabetic have impaired glucose tolerance (IGT) or insulin resistance. People with impaired glucose tolerance do not have diabetes, but are at high risk for progressing to diabetes. Each year, 1% to 5% of people whose test results show impaired glucose tolerance actually eventually develop diabetes. Weight loss and exercise may help people with impaired glucose tolerance return their glucose levels to normal. In addition, some physicians advocate the use of medications, such as metformin (Glucophage), to help prevent/delay the onset of overt diabetes.


Diabetes also can cause heart disease and stroke, as well as other long-term complications, including eye problems, kidney disease, nerve damage, and gum disease. While these problems don't usually show up in kids or teens who've had type 2 diabetes for only a few years, they can affect them in adulthood, particularly if their diabetes isn't well controlled.

Diabetes is one of the first diseases described[21] with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine."[112] The first described cases are believed to be of type 1 diabetes.[112] Indian physicians around the same time identified the disease and classified it as madhumeha or honey urine noting that the urine would attract ants.[112] The term "diabetes" or "to pass through" was first used in 230 BCE by the Greek Apollonius Of Memphis.[112] The disease was rare during the time of the Roman empire with Galen commenting that he had only seen two cases during his career.[112]

A proper diet and exercise are the foundations of diabetic care,[23] with a greater amount of exercise yielding better results.[82] Exercise improves blood sugar control, decreases body fat content and decreases blood lipid levels, and these effects are evident even without weight loss.[83] Aerobic exercise leads to a decrease in HbA1c and improved insulin sensitivity.[84] Resistance training is also useful and the combination of both types of exercise may be most effective.[84]


Triglycerides are a common form of fat that we digest. Triglycerides are the main ingredient in animal fats and vegetable oils. Elevated levels of triglycerides are a risk factor for heart disease, heart attack, stroke, fatty liver disease, and pancreatitis. Elevated levels of triglycerides are also associated with diseases like diabetes, kidney disease, and medications (for example, diuretics, birth control pills, and beta blockers). Dietary changes, and medication if necessary can help lower triglyceride blood levels.

Track3 Diabetes Tracker & Logbook App tracks an impressive number of health factors for people with diabetes, including food, blood glucose, insulin, medications, exercise and weight. Food tracking can be done out of a built-in database, or users can program their own foods and create shortcuts for quick inputs. When the user works out, they can enter calories burned right from a cardio machine or estimate them for a workout. Tracking metrics can be displayed on multiple mobile devices or on the web.
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