Classic type 1 diabetes is an autoimmune problems, so people with type 1 diabetes very frequently have other autoimmune problems such as thyroid problems, early ovarian failure, and sometimes certain kinds of anemia or hepatitis. So when people have type 1 diabetes, we look for those other conditions as well. In type 2 diabetes, it’s also associated with other classic abnormalities. Sometimes with type 2 diabetes, we talk about the metabolic syndrome or the insulin-resistant syndrome. The classic features of the insulin-resistant syndrome are all of the risk factors for diabetes: hypertension, abnormal cholesterol, heart disease, and being overweight. All of those things go with type 2 diabetes – so if a person has one of those conditions, we look for the other ones.
The people who have risk factors for type 2 diabetes need to be screened. The screening test is a very simple blood test. The most common blood test used right now is called a Hemoglobin A1c – it reflects your blood sugar for the last two or three months. We’ve got cutoffs that tell us if you have diabetes or if you are at risk for diabetes and it can be done at any time of the day. Your primary care doctor can order it – you don’t have to be fasting for it. People can also sometimes be tested with a fasting blood sugar and sometimes people use a test called an Oral Glucose Tolerance Test. That’s when you go to a lab, you drink some sugary stuff, and they test your blood sugar in about two hours. That’s the test that’s often used for pregnant women these days. If one of those tests is abnormal, it’s usually repeated just to confirm the condition. However, if you have classic symptoms of diabetes – if you’re thirsty all of the time, you’re drinking a lot of water, you’re having to urinate a lot – classic symptoms and one abnormal test, that’s good enough for a diagnosis.
Both type 1 and type 2 diabetes run in families – there is definitely a genetic component to both of them. This is particularly strong in type 2 diabetes because people with type 2 diabetes typically have a lot of relatives who have diabetes as well. People with type 1 diabetes may not have as many relatives with diabetes. In type 2, since it’s an asymptomatic condition, it’s really important to be tested because if you have a relative with diabetes, your risk is much increased. People with relatives who have diabetes need to be tested for type 2 diabetes.
The classic symptoms of diabetes are the symptoms of high blood sugar. Those symptoms are: someone could be hungry all of the time, they can have to urinate all of the time, they’re very thirsty, sometimes they will unexpectedly and unintentionally lose a lot of weight – those are the classic symptoms. But it’s really important for people to realize that you can have very high blood sugar and no symptoms at all. It’s one of those silent diseases. Even though you don’t have symptoms of diabetes, that doesn’t mean you don’t have diabetes and it doesn’t mean you’re not at risk of developing complications of high blood sugar. It’s really important for people to get tested and realize if they have it because it may be completely asymptomatic.
A pretty common myth is that diabetes occurs when someone eats too much sugar. Eating too much sugar isn’t good for anybody because sugar is one of those things with “empty calories.” Eating sugar can indirectly cause diabetes because the biggest cause of type 2 diabetes is being overweight. If someone’s eating too much sugar, they can be more likely to be overweight but sugar itself is not really the cause of type 2 diabetes.
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