What is diabetes? Types of diabetes

Written by Lucía Feito Allonca, Heath Law and Biomedicine. Patient’s Rights Specialist. Diabetes Educator.

There is a lot of talk about diabetes, but what is it really?

Is it a single health condition, or several?

Are there different causes for developing diabetes, or are there common elements?

With the aim of disseminating reliable information and education on diabetes, I attach this article that I wrote within the framework of the “This IS diabetes” campaign in Beyond Type 1, with the aim of eradicating myths and erroneous beliefs, harmful to our health.

The Latin phrase diabetes  “to pass through” comes from the Greek loan word  Dia “through” and Betes “to pass.” It is, according to the dictionary of the Royal Spanish Academy, a metabolic disease characterized by excessive urine output, weight loss, intense thirst and other general disorders.

TYPE 1 DIABETES

Type 1 diabetes was previously also known as juvenile diabetes due to the high number of diagnoses in children and young people. Today it is known that type 1 diabetes can appear at any time of life, not just childhood or adolescence.

It is a chronic condition of autoimmune origin that causes the body to be unable to produce the hormone insulin, responsible for regulating blood glucose (sugar) levels. Its symptoms are polyuria, which means frequent urination, polyphagia, which implies excessive hunger, weight loss that occurs without apparent explanation, and tiredness/fatigue.

It is important that we understand that type 1 diabetes has an autoimmune origin and that the person will depend on the external supply of the hormone insulin to live and stay healthy.

It is essential to put an end to myths and erroneous beliefs that still circulate in society, such as that “diabetes is a thing for older people” or that “insulin is for serious cases.” In type 1 diabetes, insulin is the only treatment option.

Managing type 1 diabetes involves making interventions in people's lifestyles, such as diet, exercise, and taking insulin. To carry out an adequate dosage of this hormone we must know our blood glucose (sugar) levels, a task which will require a continuous glucose meter or blood glucose measurements made with a blood sugar meter. The success of treatment will be affected by the level of commitment of the family and the environment, personal/family circumstances, as well as other socio-economic factors.

TYPE 2 DIABETES 

Diabetes 2 manifests itself when the body cannot use insulin adequately, presenting the so-called “insulin resistance.” The pancreas releases extra insulin, but over time it can't keep up with production to keep blood glucose (sugar) levels in a healthy range.

The factors that influence the appearance of type 2 diabetes are obesity, smoking, genetic factors and factors related to lifestyle, making it a multifactorial condition.

The myths that single out and stigmatize people who live with type 2 diabetes often do so because they do not understand the cause of the disease.

Also, the use of insulin seems to be associated in popular culture with negative connotations, something that we have to tackle at its roots, since allowing these erroneous beliefs has a serious associated cost: posing a psychological obstacle for many people who need it to be able to take insulin, enjoy better health and quality of life.

GESTATIONAL DIABETES

It is a type of diabetes that causes high blood glucose levels during pregnancy. It usually starts between the 13th and 28th week of the pregnancy and will disappear after the baby is born.

Gestational diabetes causes a high level of blood glucose, dangerous for your baby's health, and subsequently produces a greater risk of type 2 diabetes in the future.

LADA DIABETES 

Like type 1 diabetes, Latent Autoimmune Diabetes in Adults (LADA) is the result of an autoimmune process. This type of diabetes usually occurs in people over 30 years of age, which is why it is often misdiagnosed as type 2 diabetes.

MONOGENIC DIABETES (MODY)

Monogenic diabetes (MODY) is a type of diabetes that has characteristics of type 2 diabetes and occurs at a young age, usually before the age of 25.

It is due to mutations in certain genes (there are 7 known gene mutations at this time that cause MODY) and in a single gene subtype that affects the maturation of pancreatic beta cells (insulin-producing cells) and therefore, insulin secretion. It is a type of diabetes that is frequently misdiagnosed as type 1 or type 2 diabetes.

TYPE 3C DIABETES

It is related to pancreatic diseases such as pancreatitis (of which the most common causes are gallstones or alcohol abuse), pancreatic cancer, cystic fibrosis, pancreatic surgery and hemochromatosis.

Chronic pancreatitis is the most common cause and is often misdiagnosed as Type 2 diabetes.

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Even with these various types of diabetes, and a variety of medications/technologies available for management of the condition, we are more alike than we are different. We ALL have issues controlling blood sugar level. As noted above, the lines between the types are often blurry and easily confused by medical professionals, patients, and the general public.

Let’s spread awareness, understanding, and compassion for all people who are impacted by diabetes, of all types.

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Did you know of all the different types of diabetes? Leave a comment below to share!

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What Knitting a Sweater Teaches About Habits - and Diabetes Management

by Lisa La Nasa, founder of diaVerge Diabetes

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It’s time for New Year's goals and resolutions.

Today, I'm pulling back the curtain and showing you more about my life outside of diabetes management and social media.

Here's something you may not know about me:

I love textiles and fiber arts.
Sewing is my first love, and comes more naturally to me.

Knitting, though, has been an enigma (a mysterious, difficult, frustration) that I really want to change.

After 15 years of years trying to knit, with small projects here and there, sometimes finishing, sometimes not, I've decided that 2023 is my year to really get good at knitting.

I'm committed to honing my skills and I’m dedicating the necessary time to do so.

Lisa with a ball of yarn and new knitting set - and an unedited, unusually elongated head 🤣

In fact, I have a brand new set of knitting needles that I received for Christmas (thanks, Mom!), and I'm finally using up some wild multicolor yarn that I've had in my office/craft closet for the last 2 years.

Since I've knitted small projects previously but haven't been consistent with it, I have to start over each time and re-learn what I’ve forgotten.

I'm going for the gusto this time. No more taking years off and then expecting to pick it back up again. I'm going for something that I have to devote the time and effort to complete, that is a challenge and will build my skills.

I’m knitting a sweater.

This will take many weeks, and I need to devote the time every single day to get it done. To ensure this happens, I've scheduled it in my calendar. There’s a block of time every day for knitting.

• This is not just a hobby. It's personal development.

• It's learning and mastering a new skill.

• It’s being comfortable with the discomfort of being a beginner.

• It's practicing and learning from missteps.

• It's building consistency and doing it every day whether I feel like it or not.

And that's exactly what we need to do to build new habits and skills.

The bottom ribbing of my new sweater.

Plus, it’s setting an example of commitment and follow-through for my 10-year-old daughter who also wants to knit.

AND, it’s quality time as we chat while we knit together.

Diabetes management is also a skill — but it’s one that we don’t often think of in the same way.

As a result, this is not something that most people devote the time to mastering.

Even though we might have been practicing diabetes management for years, most of us only learn bits and pieces, then wonder why we’re not achieving the same results as people on the internet who make it look so easy. But that’s not fair for anyone because we’re comparing our starting point to others mastery.

The truth is, it’s rare that people with type 1 will ever dedicate the time needed to improved diabetes management.

If you’re one of those few, and improved health (and diabetes management) is on your goal list for 2023, start here:

1. Commit to making improved diabetes management a daily practice

2. Read Dr. Bernstein’s Diabetes Solution book. If you’ve already read it, read it again. ;)

3. Schedule time in your calendar DAILY for learning and putting information into action.

4. Review your data OFTEN (using Dexcom Clarity, Libreview or other program of your choice)

5. Adjust your inputs when needed (quantity and/or timing food, insulin & exercise)

6. Seek out help such as an accountability partner who can give you a friendly nudge and help along the way when you don’t feel like doing the work

We all have the power to see what parts of our lives may need attention, and focus our efforts on learning and growth.

It requires commitment, time, and focused action to make improvements. Just don’t leave your future up to chance.

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If you want to skip past many of the learning steps (and potential missteps) or you know you need accountability, structure and professional guidance along the path to improved health and habit formation, we can help.

diaVerge offers customized 1:1 coaching options and our flagship Diabetes Redesigned Membership (where you’ll get lifetime support and a Success Guarantee).

If you’re ready to build the habits of improved diabetes management, schedule a no-pressure call with me so I can learn more about you, your experiences with diabetes, and what might best help you reach your goals.

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20 Mainstream Beliefs That Keep People with T1D Sick

Imagine you were in a class where only 24% of the students achieve a passing grade.

That would feel pretty impossible, right? You might feel depressed, working as hard as you could, knowing that the overwhelming majority of your class would not succeed. Like a mouse on a wheel, doing everything you can, while getting absolutely nowhere.

A 24% pass rate might tell us that the students weren’t prepared. It even might call into question the teaching methods and resources used.

The American Diabetes Association (ADA) has published that only 24% of adults with T1D ages 18+ are achieving the A1c target of <7% (53 mmol/mol). That percentage is even lower for children.

That’s heartbreaking. What’s happening and why?

With all of today’s tools and technology, why aren’t more people meeting the ADA’s target A1c level?

What we’ve uncovered is a series of common beliefs that people with type 1 diabetes are being taught. These beliefs/misconceptions/myths/lies (whatever you want to call them), are NOT promoting health, in many cases, keeping people with T1D far from achieving a 7% A1c, and often in declining health due to chronically high blood sugar levels.

1. “People need to eat 30-45 grams of carbohydrates at each meal to live.”

   Actually, there’s no such thing as an essential carbohydrate. Our bodies produce all the glucose that our brains need through gluconeogenesis and glycolysis.

2. “Kids need carbs to grow.”

   Kids do not need carbs to grow, they need protein (and lots of it), and all the essential amino acids and fatty acids that come along with protein. High blood sugar levels caused by a high-carb diet can cause cognitive issues in kids.

3. “Even non-diabetics have large blood sugar spikes.”

   Metabolically healthy individuals eating whole foods do not have large blood sugar spikes. If you’re prediabetic, T2, and/or eating a lot of heavily processed carbs, yes, you will experience large blood sugar spikes. This isn’t healthy for anyone.

4. “Highs and lows are inevitable.”

   High blood sugar levels are due to excess dietary carbs and a mismatch with injected insulin. Lows are due to too much insulin being used to treat the carbs being eaten. It’s a vicious cycle. When you cut back on the carbs, you reduce insulin needs, greatly reducing the dangers of hypoglycemia.

5. “An A1c of 7.0% (which is the ADA target for adults) is normal.”

   Non-diabetic A1c levels are 5.6 % and below. 7.0% is hyperglycemia.

6. “Diabetes is a progressive disease”

   See #4 and #5. Hyperglycemia (high blood sugar level) is proven to cause cellular damage throughout the body, causing diabetic complications. If you control blood sugar levels, you greatly reduce the risk of diabetic complications.

7. Diabetic complications only start after many years with diabetes

   Complications can start within 10 years after diagnosis.

8. “Whole grains are good for you.”

   Read Grain Brain by David Perlmutter MD, or Wheat Belly by William David MD

9. “Protein is bad for your kidneys.”

   Protein will not damage healthy kidneys.

10. “You only need to test your blood sugar level 3-4x per day.”

    A GGM (continuous glucose monitor) is best, but if you don’t have a CGM, finger-prick testing multiple times per day (as many as you can, up 10 10-12x per day) will give you a decent picture of what’s happening with your blood sugar levels.

11. “Only correct when your blood sugar level is over 250 mg/dL.”

    To avoid hyperglycemia, we need to correct our blood sugar long before it reaches 250 mg/dL. By learning how to correct your blood sugar to your target range, you can do so precisely and safely, maintaining much lower, healthier range overall.

12. “Once you have complications, it's too late to improve your health.”

    It’s never too late to gain control of your blood sugar levels and halt (or potentially reverse) diabetic complications. Retinopathy and neuropathy require very slow and steady blood sugar improvement so as to not worsen those conditions, but it can be done safely.

13. “You can't lose weight because of diabetes.”

    High doses of insulin can cause weight gain, which causes insulin resistance, requiring more insulin. Another vicious cycle.

14. “You can't exercise because of diabetes.”

    Many people experience hypoglycemia (lows) while exercising because they have too much active insulin onboard. By reducing our insulin needs, we can exercise more safely and consistently, without having our best intentions derailed by lows.

15. “All sugary foods are equal when treating low blood sugar levels.”

    Not so. We want a fast-acting, measurable, portable supply of glucose to treat a low. Liquid glucose is ideal because it does not have to be digested before starting to raise blood sugar, like food does.

16. “Eating food that is different than what others eat is alienating, will cause emotional distress and/or an eating disorder.”

    If we normalize our experience, others will as well. Many people will never even notice what you eat. Others won’t care.

17. “An insulin pump is the only way to have better blood sugar levels.”

    An Insulin pump can be a great tool, but pumps are not the only way. Injections are also great, but they’re also not the only way. You can achieve great blood sugar levels with pumping or injections. There are best-practices and testing involved with both options.

18. “You can eat whatever you want and cover it with insulin.”

    Rapid-acting insulin has a very sharp peak of action that is difficult if not impossible to match precisely with the sharp peak of high carbohydrate foods. it’s not your fault; it’s the diet PLUS the modern insulins that have been created to ‘handle' the standard carb-heavy diet.

19. “A low carb diet is unsustainable long-term.”

    A properly formulated and personalized eating plan that helps you achieve more steady blood sugar levels is sustainable, and is easier now than ever before.

20. “Normalized blood sugar levels (as a T1D) are dangerous, or impractical or impossible.”

    People with type 1 diabetes DESERVE to have the tools to normalize their blood sugar levels, but we’re not given the options by our medical professionals. With the proper training, normal, steady NON-diabetic blood sugar ranges are achievable, sustainable and healthy for those of us with type 1 diabetes.

It hurts me to my core because often, people with T1D are shamed by our medical professionals because we're not achieving the ADA's A1c guidelines.

But the game is rigged.

We can't win by following the standard rules. 

After 13 years of type 1 diabetes, I was suffering from IBS, severe clinical depression, and worsening kidney function. I felt hopeless. I was doing everything right according to my doctors, but it never felt right to me and I still wasn’t achieving that mythical 7% A1c.

Now, after 7 years of eating low carb and easily maintaining an A1c level of < 5.5 %, it’s obvious that standard methods of diabetes management are leading to all the terrible, degenerative outcomes of diabetes.  

I’ll always require insulin and nothing is going to change that. But I no longer suffer from my previous list of complications. My blood sugar levels are predictable, and on the rare occasion my numbers are off, I know exactly what to do to correct them to target quickly and safely so I can get on with my life.

That’s what we all deserve.

*The list above was based on a diaVerge Facebook post from 2017.

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If you're tired of struggling and want something better for yourself, join us.

To learn if diaVerge Diabetes programs are right for you, schedule a complimentary consultation.

Check out our testimonials for what our members say.

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Resource list:

https://diabetesjournals.org/care/article/38/6/971/37394/Current-State-of-Type-1-Diabetes-Treatment-in-the

https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

https://beyondtype1.org/type-1-diabetes-statistics/

https://www.endocrineweb.com/guides/diabetic-neuropathy/diabetic-neuropathy-overview

https://diabetesjournals.org/care/article/44/2/301/35481/The-Evolution-of-Hemoglobin-A1c-Targets-for-Youth

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Attitude is Everything

by Ashley Harris for diaVerge Diabetes

Parenting a child with type 1 diabetes is a lot like parenting a child without type 1 diabetes...or at least it should be. We have a responsibility to teach our kids (chronic disease or not) how to make good decisions...decisions that are going to keep them healthy and happy. We need to set boundaries for our kids that are going to keep them safe. It's our job to ensure that we are raising kids that are confident and secure in who they are. Kids that can stand up for themselves and make the decisions that are right FOR THEM. We want to raise kids that feel empowered and in control of their lives. 

What can we, as parents, do to help our child that is living with type 1 diabetes feel empowered and in control of their disease and their life?

How can we ensure that we are not only providing our kid with the best physical health possible but that we are also fostering, within our kid, a healthy mindset and attitude towards living well with type 1 diabetes?

1) We can't allow ourselves or our child to feel like a victim of this disease.

Let's teach our child that THEY control their type 1 diabetes, it does NOT control them.

One mentality that is rampant within the diabetes community is that "diabetes has a mind of its own." This insinuates that there is absolutely no rhyme or reason to how blood sugars behave and perpetuates the idea that type 1 diabetes cannot be well-controlled. This type of attitude can do serious damage to our kid's perspective of their health. When we portray to our child that there is no way to make sense of their blood sugar, we are teaching them that they are nothing but a passive observer to the outcome of their health. There is nothing they can do, diabetes is unpredictable, they might as well not even try. 

Instead, let's teach our child that type 1 diabetes CAN be controlled! There are steps our kid can take to make understanding and predicting their blood sugar easier. Eating a low carb diet significantly increases the odds that they will be successful in determining the cause of blood sugar fluctuations. This is empowering for kids with type 1 diabetes because they no longer feel like their diabetes is a thing they have no control over.

They begin to see that consistent inputs produce consistent outputs. Success breeds motivation. As our child starts to believe that they CAN, in fact, control their blood sugar, they are motivated and encouraged to continue doing so.

2) Type 1 diabetes does not dictate what they choose to do and who they choose to become.

THEY are the ones in control of their life...not diabetes. We should be encouraging our kids to get involved in any activity that they may be interested in. Our child needs to know that having type 1 diabetes should not limit their activities in any way. Again, we must stress to our kids that the way for them to stay in the driver's seat, is by maintaining control of their diabetes. As long as they commit to keeping themselves healthy, there are no limits as to what they can do!

3) We must eradicate the idea that "fitting in" is the end all be all for our kids.

When something as traumatic as a type 1 diabetes diagnosis happens within our family, it can throw off our parenting game. As a type of defense mechanism, we look for any way that our kid can remain a "normal" kid. In an instant, we go from being the parent preaching "It’s okay to be different!" to the parent breaking our neck to prevent our kid from ever appearing different in any way.

The simple truth is, having type 1 diabetes DOES make our kid different. Instead of denying that truth, let's teach our child that being different is never something to be ashamed of. 

Many parents get hung up on the idea that their kid's self-esteem is going to shrivel up and die if they don't allow them to eat Cheetos and Little Debbies at school like their friends. I know that for my daughter, I hope that her sense of self-esteem is built on something more substantial than how similar she can be to her friends.

I want my daughter to be confident enough to stand up for herself and to make her own decisions about what is best for her. Maybe this means that she brings her own low carb cupcake to a birthday party or takes a different snack to eat at school.

Do I really want to teach my child that "fitting in" is more important than taking care of her body and her health? Absolutely not.

4) Commit to eating low carb with your child.

Show them by example that low carb.can be delicious and satisfying and that you don't feel deprived eating this way. We all know that our kids are much more likely to do as we do than to do as we say. Your child needs to see that you are committed to a healthy lifestyle right alongside them. Making sure that you have a healthy relationship with food is going to go a long way in helping your child to develop a healthy relationship with food.

5.) Diabetes Care is Non-Negotiable.

Parental fears can greatly influence how a child responds to diabetes. If a parent is scared to do an injection, a child will see that it’s something to be feared. If a parent gives a choice, anxiety will often build up and make the event more traumatic than it otherwise would have been. There’s a reason that nurses do vaccinations quickly and it’s over before you know the injection has even happened. It’s no-nonsense. Done.

We need to teach our children to do what they need to do to take care of themselves, in a calm and matter-of-fact manner, so they can move on with their day.

Raising a child with type 1 diabetes to be a confident and secure individual means being intentional in showing them that this disease is only a small part of them, it does not define who they are. It means showing them that THEY are the captain of their ship. It is up to them to make wise decisions that will keep diabetes from interfering with their plans. It means teaching them to strike a balance between acknowledging how diabetes needs to play into their decision making while knowing that THEY retain the power to steer their life in whatever direction they choose...and having type 1 diabetes can never take that power away from them.

Ideal Treatment of Hypoglycemia - Plus Alternatives

There is no denying that pure glucose or dextrose (the crystalline form of glucose) is by far the fastest and most accurate way to treat a low blood sugar level.

Dr. Bernstein's Diabetes Solution book states: 

"Glucose, the sugar of blood sugar, does not have to be digested or converted in the liver to anything else. Unlike other sweets, it's absorbed into the blood directly thought the mucous membranes of the stomach and gut. Furthermore...we can compute precisely how much a fixed amount of glucose will raise blood sugar." Dr. Bernstein's Diabetes Solution book  (2011) p. 339

Glucose tablets are portable, measurable, predictable and fast-Acting. It's the ideal combination. 

But they lack one important criterion: readily available. 

In my experience living on three continents within the last two years and working with people all over the world, I've learned that glucose tablets are not frequently available outside of the USA and Canada. In North America, we seem to assume that the same goods are available everywhere. They're not.

Glucose tablets are nearly impossible to find in some places of the world or so exorbitantly priced that they're out of reach of many. 

So while not ideal, we do what we have to do. 

As an alternative to glucose tablets, you can use 'Dr. Bernstein Approved' candy similar to 'Smarties" in the USA.

(Please note, these are different than Smarties in Europe).  Dr. Bernstein also recommends 'Bottle caps" or SweeTARTS candies (or similar) as alternatives and lists these on page 343 of Dr. Bernstein's Diabetes Solution book. These small candies often contain nearly 100% glucose/dextrose and similar candies can be found in many countries.

Avoid any candy with a sugary shell such as Skittles, M&M's, Rocklets and many others, particularly chocolates, as these will be digested much slower due to the waxes and fats contained.

You also want to avoid treating a low blood sugar level with food or beverages. Food is not measurable, predictable or fast acting. When treating hypoglycemia with food, we usually end up eating far too much (defeating the Law of Small Numbers) before the symptoms of our low blood sugar are alleviated and as a result, creating a rebound-high. 

 

 

Another approved alternative is glucose/dextrose powder which is normally more accessible than tablets.

Glucose powder and/or Dextrose granules are a great way to treat a low blood sugar level at home. You can measure the appropriate amount of powder/granules to treat your blood sugar level and mix with water to drink. Alternately, if you want to create a great chemistry experiment, you can attempt to make your own glucose tablets at home.

I've also tried powdered glucose packets available at some pharmacies that recommend pouring into the mouth directly. I DO NOT RECOMMEND these, nor do I recommend pouring ANY powdered glucose directly into your mouth because of the probability of aspirating (breathing in) the powder. Been there. Done that. Not fun. 

Out of all of the options, the most accessible thing that I've found worldwide is sugar... 

And I wrote about it here while living in Argentina for 5 years. While table sugar is not ideal because of the fructose/glucose combination which slightly slows the absorption, it's available in small packets which meets the requirements of portable, measurable, readily available and fast-acting (although as I mentioned, slightly slower than pure glucose). 

Is TABLE sugar ideal to treat a low? No

Will it work? Yes

There are many tips and tricks to diabetes management-- which is obvious by the sheer size of Dr. Bernstein's Diabetes Solution book. We always want to remember the Law of Small Numbers and in the treatment of hypoglycemia, the key requirements of small, measurable, predictable corrections.  

But I will never be a purist about glucose tablets. Glucose tablets are amazing and I highly recommend glucose tablets if you have access to them. 

But if you can't get glucose tablets, look for the approved alternatives listed above.

Then there are other alternatives, like sugar, that I see as the lesser of all the other evils. 

I will never say that glucose is the ONLY way to effectively treat a low blood sugar level because I've been there for years - without any access to glucose tablets - and using what I could to keep the corrections small, measurable and predictable.

We all do what we have to do. 

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For more information on Hypoglycemia and the Treatment of Lows (including a chart on how to calculate your corrections based on body weight) click the red link to the diaVerge article. 

If you're interested in making a change towards more optimal diabetes management and don't know where to start, or have questions, we'd love to help you improve your diabetes management and quality of life. More info at diaVerge Diabetes Education & Coaching. 

If you still haven't read Dr. Bernstein's Diabetes Solution book or want to buy another copy as a gift to your doctor or a friend, click the link to buy it on Amazon. 

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