Diabetes

Diabetes occurs when the body cannot regulate blood glucose (blood sugar) properly. This happens when the body does not produce enough insulin or cannot use insulin effectively. Insulin is the hormone that helps move glucose from the bloodstream into cells for energy. 

Over time, high levels of blood glucose can damage the heart, kidneys, eyes, nerves and blood vessels. 

The most common types are:

• Type 1 diabetes is an autoimmune condition in which the body stops producing insulin. It is the most common type of diabetes in children and young adults but can occur at any age.
• Type 2 diabetes occurs when the body does not use insulin properly and gradually cannot produce enough insulin. More than 95% of people with diabetes have type 2 diabetes. Type 2 diabetes is linked to genetics, ageing and lifestyle factors.
• Gestational diabetes is when blood glucose levels during pregnancy are higher than normal but not high enough to meet the criteria for diabetes outside of pregnancy. Women who have had gestational diabetes and their children have a higher risk of developing type 2 diabetes later in life.

Common symptoms of both type 1 and type 2 diabetes can develop gradually and include:

• feeling very thirsty or hungry
• frequent urination
• extreme fatigue
• blurred vision
• unexplained weight loss.

In type 1 diabetes, these symptoms usually develop quickly over days to weeks and are often more pronounced than for type 2 diabetes. Sometimes they are accompanied by nausea, vomiting or rapid breathing in the case of a very high blood glucose level. 

In type 2 diabetes, symptoms can be mild or absent and may take several years to be noticed.

Diabetes is diagnosed using blood glucose measurements. Commonly used tests include:

• fasting plasma glucose (FPG): blood glucose measured after an overnight fast;
• oral glucose tolerance test (OGTT): blood glucose measured before and after drinking a glucose solution to see how the body handles sugar;
• HbA1c: reflects average blood glucose over the past 2–3 months; and
• random plasma glucose: a blood glucose test taken at any time; this can be used to support diagnosis in people with classic symptoms of hyperglycaemia or a hyperglycaemic crisis.

Each test has specific thresholds for diagnosing diabetes. The choice of test may depend on clinical context, resources and preference.

High blood glucose can damage blood vessels and nerves over time, leading to serious damage to many of the body's systems. This increases the risk of heart disease and stroke, kidney failure, vision loss, foot ulcers and lower-limb amputation.

Good diabetes care seeks to prevent these complications.

Treatment and management of diabetes depend on the type of diabetes, but generally includes:

• healthy eating and regular physical activity;
• blood glucose monitoring;
• medication, such as insulin for type 1 diabetes, and oral and/or injectable medicines for type 2 diabetes;
• support for self-management, including education and psychosocial support;
• management of other risk factors, such as high blood pressure and cholesterol; and
• regular screening and treatment for complications, including eye, kidney, nerve and foot care, to prevent disability and premature death.

Effective diabetes care requires long-term, integrated follow-up within primary health care, with referral to specialized services when needed.

At present, type 1 diabetes cannot be prevented.

Type 2 diabetes, however, can often be prevented or delayed, particularly among people at increased risk. Effective measures include:

• regular physical activity
• healthy diets that limit excess energy intake, sugar and unhealthy fats
• maintaining a healthy body weight
• avoiding tobacco use.

In addition to individual actions, communities, health systems and policies play a crucial role by creating environments that support healthy behaviours, early detection, and equitable access to preventive care.

If someone you know is living with diabetes, a helpful first step is to ask them what you can do to support them. Making the effort to inform yourself using reliable sources such as the WHO website will help you to better understand diabetes.

Other tips for supporting someone living with diabetes:

• ask them about the challenges they face living with diabetes and listen to their answer without judgement;
• avoid making comments about their lifestyle or diabetes management, for example, by commenting on what they eat; and
• be a trusted person they can talk to – sometimes listening is more helpful than offering solutions.