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]
Clearly separate from the characteristic lack of acute insulin secretion in response to increase in glucose supply is the matter of total mass of β-cells. The former determines the immediate metabolic response to eating, whereas the latter places a long-term limitation on total possible insulin response. Histological studies of the pancreas in type 2 diabetes consistently show an ∼50% reduction in number of β-cells compared with normal subjects (66). β-Cell loss appears to increase as duration of diabetes increases (67). The process is likely to be regulated by apoptosis, a mechanism known to be increased by chronic exposure to increased fatty acid metabolites (68). Ceramides, which are synthesized directly from fatty acids, are likely mediators of the lipid effects on apoptosis (10,69). In light of new knowledge about β-cell apoptosis and rates of turnover during adult life, it is conceivable that removal of adverse factors could result in restoration of normal β-cell number, even late in the disease (66,70). Plasticity of lineage and transdifferentiation of human adult β-cells could also be relevant, and the evidence for this has recently been reviewed (71). β-Cell number following reversal of type 2 diabetes remains to be examined, but overall, it is clear that at least a critical mass of β-cells is not permanently damaged but merely metabolically inhibited.

Asian. Diabetes is the fifth-leading cause of death for Asian or Pacific Islander women in the United States.10 However, it may be more or less common for women of different Asian heritage groups to be diagnosed with diabetes. One in every 33 Chinese-American women is diagnosed with diabetes compared to 1 in every 10 Asian Indian women.1 It is also more common for Asian women to develop gestational diabetes compared to white women.11

A: Fasting plasma glucose and weight change 2 years after randomization either to gastric banding or to intensive medical therapy for weight loss and glucose control. Data plotted with permission from Dixon et al. (13). B: Early changes in fasting plasma glucose level following pancreatoduodenal bypass surgery. A decrease into the normal range was seen within 7 days. Reproduced with permission from Taylor (98).
In addition, getting too little sleep can increase your appetite and reduce your level of satiety, causing you to crave carbohydrates and sugary foods, in particular. Over time, indulging in these cravings or overeating, in general, can wreak havoc on your insulin and blood sugar levels, as well as your body weight. (Remember: Obesity is a major risk factor for type 2 diabetes.) Plus, when you’re short on sleep, you’re more likely to feel tired and less inclined to exercise, which is a problem because regular exercise helps with weight management and blood sugar control.
Type 2 diabetes primarily occurs as a result of obesity and lack of exercise.[1] Some people are more genetically at risk than others.[6] Type 2 diabetes makes up about 90% of cases of diabetes, with the other 10% due primarily to diabetes mellitus type 1 and gestational diabetes.[1] In diabetes mellitus type 1 there is a lower total level of insulin to control blood glucose, due to an autoimmune induced loss of insulin-producing beta cells in the pancreas.[12][13] Diagnosis of diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or glycated hemoglobin (A1C).[3]
Cons: MySugr doesn’t sync with blood glucose meters, but Apple users can use the MySugr Scanner app to scan and import readings, though the app can be glitchy. Does not sync with insulin pumps. To generate health reports as PDFs, you must buy MySugr PRO. The MySugr Coaching feature—a nice touch—is available only on Apple devices, and it can take a couple of hours to a few days to be able to text with a health coach through the app.
When Dan Hamilton was diagnosed with T1D in 1972, the doctor told him he wouldn’t live past 50. Fast forward 45 years, and Dan is strong and healthy at 59. He credits his health to the advancements in treatment and care over the years. He has been an early adopter of every technology that has come along, and exercises regularly as part of a healthy lifestyle.
"It's never been easier to manage diabetes with all the technological stuff we have at our fingertips," said Steve Lisowski, who lives in Chicago. Lisowski has had type 2 diabetes for 15 years, and currently uses an insulin pump and a continuous glucose monitor to help manage his diabetes. He has used nutrition apps and an overall diabetes-management app.
BlueStar Diabetes is an FDA-approved, Class 2 medical app which provides approved diabetics with 24/7, real-time coaching from a certified diabetes specialist. This comprehensive app is available only by prescription and offers an impressive range of tools tailored to the individual. When registered, users can receive personalized guidance based on their blood glucose, medications, current health, and a review of lifestyle factors.

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.

Glucose Buddy Diabetes Tracker also allows you to track insulin, carbohydrates, weight, and ketones.  It allows users to save and view a history of their blood sugar records which helps you identify trends in your health.  You can schedule reminders to measure your blood sugar. The app tracks what time of day you are checking your blood sugar.  You can also add a note to each record.  Glucose integrates with HealthKit by writing all inputted entries to the Health app.  Subscriptions are available for premium features such as other apps, graphs, and custom tagging tools.
"A little diabetes monster accompanies the kids through the app and gives feedback on their entries. The child can enter data such as blood glucose levels, food and insulin or take a picture of his meals, but they can also request help whenever the parents are not around. All entries can be sent as a push message or email from within the app to the parents' phone. This way, the child can ask for feedback on calculating carbs or the insulin dose." 
This British-made diabetes app raised $11,600 on Kickstarter in February 2013. It's a free app for diabetes management that focuses on quick data entry and aesthetically designed interactive charts, as well as reminders that can trigger either at a particular time or in particular location. The app helps people with both type 1 and type 2 diabetes monitor how much and how often they’re eating, their blood glucose levels, and whether they’ve taken their medication.
Some kids and teens are already using devices that make blood glucose testing and insulin injections easier, less painful, and more effective. One of these is the insulin pump, a mechanical device that can deliver insulin more like the pancreas does. There's also been progress toward the development of a wearable or implantable "artificial pancreas." This consists of an insulin pump linked to a device that measures the person's blood glucose level continuously.
Studies in type 1 patients have shown that in intensively treated patients, diabetic eye disease decreased by 76%, kidney disease decreased by 54%, and nerve disease decreased by 60%. More recently the EDIC trial has shown that type 1 diabetes is also associated with increased heart disease, similar to type 2 diabetes. However, the price for aggressive blood sugar control is a two to three fold increase in the incidence of abnormally low blood sugar levels (caused by the diabetes medications). For this reason, tight control of diabetes to achieve glucose levels between 70 to120 mg/dl is not recommended for children under 13 years of age, patients with severe recurrent hypoglycemia, patients unaware of their hypoglycemia, and patients with far advanced diabetes complications. To achieve optimal glucose control without an undue risk of abnormally lowering blood sugar levels, patients with type 1 diabetes must monitor their blood glucose at least four times a day and administer insulin at least three times per day. In patients with type 2 diabetes, aggressive blood sugar control has similar beneficial effects on the eyes, kidneys, nerves and blood vessels.
An individual with type 2 diabetes has the same level of heart attack risk as someone who's already had a heart attack, according to the National Heart, Lung, and Blood Institute. There are numerous reasons for the link between diabetes and heart disease, Dr. Sullivan says, including a "group attack" from diabetes and other heart disease risk factors like high blood pressure and high cholesterol, which already affect many people with type 2 diabetes.

Clearly separate from the characteristic lack of acute insulin secretion in response to increase in glucose supply is the matter of total mass of β-cells. The former determines the immediate metabolic response to eating, whereas the latter places a long-term limitation on total possible insulin response. Histological studies of the pancreas in type 2 diabetes consistently show an ∼50% reduction in number of β-cells compared with normal subjects (66). β-Cell loss appears to increase as duration of diabetes increases (67). The process is likely to be regulated by apoptosis, a mechanism known to be increased by chronic exposure to increased fatty acid metabolites (68). Ceramides, which are synthesized directly from fatty acids, are likely mediators of the lipid effects on apoptosis (10,69). In light of new knowledge about β-cell apoptosis and rates of turnover during adult life, it is conceivable that removal of adverse factors could result in restoration of normal β-cell number, even late in the disease (66,70). Plasticity of lineage and transdifferentiation of human adult β-cells could also be relevant, and the evidence for this has recently been reviewed (71). β-Cell number following reversal of type 2 diabetes remains to be examined, but overall, it is clear that at least a critical mass of β-cells is not permanently damaged but merely metabolically inhibited.

Diabetic ketoacidosis can be caused by infections, stress, or trauma, all of which may increase insulin requirements. In addition, missing doses of insulin is also an obvious risk factor for developing diabetic ketoacidosis. Urgent treatment of diabetic ketoacidosis involves the intravenous administration of fluid, electrolytes, and insulin, usually in a hospital intensive care unit. Dehydration can be very severe, and it is not unusual to need to replace 6-7 liters of fluid when a person presents in diabetic ketoacidosis. Antibiotics are given for infections. With treatment, abnormal blood sugar levels, ketone production, acidosis, and dehydration can be reversed rapidly, and patients can recover remarkably well.
If the rapid changes in metabolism following bariatric surgery are a consequence of the sudden change in calorie balance, the defects in both insulin secretion and hepatic insulin sensitivity of type 2 diabetes should be correctable by change in diet alone. To test this hypothesis, a group of people with type 2 diabetes were studied before and during a 600 kcal/day diet (21). Within 7 days, liver fat decreased by 30%, becoming similar to that of the control group, and hepatic insulin sensitivity normalized (Fig. 2). The close association between liver fat content and hepatic glucose production had previously been established (20,22,23). Plasma glucose normalized by day 7 of the diet.

Prediabetes occurs when blood sugar levels are higher than they should be, but not high enough to officially be diagnosed as diabetes. Pre-diabetes greatly increases the risk of developing type 2 diabetes. The good news is that, if you have prediabetes, you can prevent or delay the onset of full-blown type 2 diabetes by making lifestyle changes. These include eating a healthy diet, reaching and maintaining a healthy weight, and exercising regularly.

Diabetic nephropathy (kidney damage). This is damage to the blood vessels in your kidneys. This means your kidneys have trouble filtering out waste. Some people who have nephropathy will eventually need dialysis (a machine treatment that eliminates waste from the blood) or a kidney transplant. The risk for nephropathy is increased if you have both diabetes and high blood pressure, so it is important to control both of these conditions. Protein in the urine is usually the first sign of nephropathy. This should be checked yearly.
Type 1 and type 2 diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400–500 AD with type 1 associated with youth and type 2 with being overweight.[112] 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.[112] Effective treatment was not developed until the early part of the 20th century when the Canadians Frederick Banting and Charles Best discovered insulin in 1921 and 1922.[112] This was followed by the development of the long acting NPH insulin in the 1940s.[112]
Findings from the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) have clearly shown that aggressive and intensive control of elevated levels of blood sugar in patients with type 1 and type 2 diabetes decreases the complications of nephropathy, neuropathy, retinopathy, and may reduce the occurrence and severity of large blood vessel diseases. Aggressive control with intensive therapy means achieving fasting glucose levels between 70-120 mg/dl; glucose levels of less than 160 mg/dl after meals; and a near normal hemoglobin A1c levels (see below).

The relationship between type 2 diabetes and the main modifiable risk factors (excess weight, unhealthy diet, physical inactivity and tobacco use) is similar in all regions of the world. There is growing evidence that the underlying determinants of diabetes are a reflection of the major forces driving social, economic and cultural change: globalization, urbanization, population aging, and the general health policy environment.[74]

Most people who develop type 2 diabetes first have insulin resistance, a condition in which the body's cells use insulin less efficiently than normal. As insulin resistance develops, more and more insulin is needed to keep blood sugar levels in the normal range. To keep up with the increasing need, insulin-producing cells in the pancreas (called beta cells) make larger amounts of insulin. Over time, the beta cells become less able to respond to blood sugar changes, leading to an insulin shortage that prevents the body from reducing blood sugar levels effectively. Most people have some insulin resistance as they age, but inadequate exercise and excessive weight gain make it worse, greatly increasing the likelihood of developing type 2 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]
Fasting plasma glucose concentration depends entirely on the fasting rate of hepatic glucose production and, hence, on its sensitivity to suppression by insulin. Hepatic insulin sensitivity cannot be inferred from observed postprandial change in hepatic glycogen concentration because glucose transport into the hepatocyte is not rate limiting, unlike in muscle, and hyperglycemia itself drives the process of glycogen synthesis irrespective of insulin action. Indeed, postprandial glycogen storage in liver has been shown to be moderately impaired in type 2 diabetes (50) compared with the marked impairment in skeletal muscle (51).
The major eye complication of diabetes is called diabetic retinopathy. Diabetic retinopathy occurs in patients who have had diabetes for at least five years. Diseased small blood vessels in the back of the eye cause the leakage of protein and blood in the retina. Disease in these blood vessels also causes the formation of small aneurysms (microaneurysms), and new but brittle blood vessels (neovascularization). Spontaneous bleeding from the new and brittle blood vessels can lead to retinal scarring and retinal detachment, thus impairing vision.

In animals, diabetes is most commonly encountered in dogs and cats. Middle-aged animals are most commonly affected. Female dogs are twice as likely to be affected as males, while according to some sources, male cats are also more prone than females. In both species, all breeds may be affected, but some small dog breeds are particularly likely to develop diabetes, such as Miniature Poodles.[123]


Since cardiovascular disease is a serious complication associated with diabetes, some have recommended blood pressure levels below 130/80 mmHg.[89] However, evidence supports less than or equal to somewhere between 140/90 mmHg to 160/100 mmHg; the only additional benefit found for blood pressure targets beneath this range was an isolated decrease in stroke risk, and this was accompanied by an increased risk of other serious adverse events.[90][91] A 2016 review found potential harm to treating lower than 140 mmHg.[92] Among medications that lower blood pressure, angiotensin converting enzyme inhibitors (ACEIs) improve outcomes in those with DM while the similar medications angiotensin receptor blockers (ARBs) do not.[93] Aspirin is also recommended for people with cardiovascular problems, however routine use of aspirin has not been found to improve outcomes in uncomplicated diabetes.[94]
The first hint that type 2 diabetes is a fully reversible syndrome came from bariatric surgery. Almost a quarter century ago, Pories et al. (12) demonstrated that blood glucose levels normalized in obese people with type 2 diabetes undergoing bariatric surgery and that 10 years later, almost 90% remained free of diabetes. The phenomenon was more recently tested in a randomized prospective study comparing gastric banding with intensive medical therapy for type 2 diabetes (13). This least invasive type of surgery was most suitable for the randomized study, although it was associated with lower rates of diabetes reversal than other procedures. Mean fasting plasma glucose fell to normal levels in the surgically treated group but declined only modestly in the intensive medical treatment group despite oral agents and insulin (Fig. 1) (13). Remission of diabetes was related to the degree of weight loss rather than to group allocation and was achieved in 73% of the surgical group and 13% of the intensive medical treatment group because surgery was more effective in achieving weight loss as previously described (14). Type 2 diabetes can be reversed by applying a surgical procedure that diminishes fat mass.
Type 2 DM is primarily due to lifestyle factors and genetics.[44] A number of lifestyle factors are known to be important to the development of type 2 DM, including obesity (defined by a body mass index of greater than 30), lack of physical activity, poor diet, stress, and urbanization.[16] Excess body fat is associated with 30% of cases in those of Chinese and Japanese descent, 60–80% of cases in those of European and African descent, and 100% of Pima Indians and Pacific Islanders.[10] Even those who are not obese often have a high waist–hip ratio.[10]
The authors: David Kerr, MD, is the director of research and innovation at the William Sansum Diabetes Center in Santa Barbara, California, and the creator of ’Appy Feet, an app for people with painful diabetic neuropathy, as well as DiabetesTravel.org and ExCarbs.com—two free resources for people with diabetes. Charis Hoppe is a project coordinator at the William Sansum Diabetes Center for the Santa Barbara 1,000 project. Ceara Axelrod is a data analyst and clinical researcher at the William Sansum Diabetes Center.

Diabetes:M is an award-winning diabetes logbook app that was first published in Google Play in April 2013. It was developed by diabetics to meet the needs of people who want to manage all aspects of their condition. Users can track, analyze, review and export data in great detail. Today Diabetes:M is an established tool with nearly 350 000 installations and over 50 000 active users. The application is well known to medical professionals, with many diabetes specialists recommending it to their patients.


The term "type 1 diabetes" has replaced several former terms, including childhood-onset diabetes, juvenile diabetes, and insulin-dependent diabetes mellitus (IDDM). Likewise, the term "type 2 diabetes" has replaced several former terms, including adult-onset diabetes, obesity-related diabetes, and noninsulin-dependent diabetes mellitus (NIDDM). Beyond these two types, there is no agreed-upon standard nomenclature.[citation needed]
DM occurs when the body cannot produce enough insulin or cannot respond appropriately to insulin. Insulin is a hormone that the body needs to absorb and use glucose (sugar) as fuel for the body’s cells. Without a properly functioning insulin signaling system, blood glucose levels become elevated and other metabolic abnormalities occur, leading to the development of serious, disabling complications.
If the amount of insulin available is insufficient, or if cells respond poorly to the effects of insulin (insulin insensitivity or insulin resistance), or if the insulin itself is defective, then glucose is not absorbed properly by the body cells that require it, and is not stored appropriately in the liver and muscles. The net effect is persistently high levels of blood glucose, poor protein synthesis, and other metabolic derangements, such as acidosis.[59]
After one year (a pretty impressive length for a study like this), there were no differences in the hemoglobin A1C levels (the best way to monitor long-term blood glucose control) between the three groups. There were also no differences in the health-related quality of life measures for the patients. There were no differences in the number of times they experienced hypoglycemia, how much care they needed, and how many progressed to the need for insulin.
SparkPeople bills itself as “your personal diet and lifestyle coach,” helping you track small details but also offer a bird's eye view of your wellness. You track your data using its food database, bar-code scanner, and exercise logs. It will sync with many fitness trackers and has built-in videos with exercise demonstrations, as well as a meal-planning function.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
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