What's Your Type of Diabetes?

Nearly 30 million Americans have diabetes, a condition in which your body does not produce or properly use insulin. The Mount Sinai Health System has extensive experience helping people with diabetes live healthy and productive lives.

Insulin is a hormone that allows your body to use the sugar in food to produce energy. Sugar that does not get into the cells stays in the blood, where it can increase your risk for heart disease or stroke and damage the nerves, eyes, and kidneys. No one knows exactly what causes diabetes, but having a family member with diabetes, being overweight or obese, and not getting enough exercise make it more likely that you will develop diabetes.

Of those 30 million people who have diabetes in America, nearly 30 percent do not know it. Diabetes can affect anyone, but some people are more likely to develop the disease than others. The symptoms of diabetes can seem harmless which is why many people do not realize they have it. If left untreated, diabetes can damage your organs, blood vessels, and nerves.

Both type 1 and type 2 diabetes result from a combination of genetic and environmental factors. For example if one identical twin has type 1 diabetes, there is greater than 50 percent chance the other twin will have type 1 diabetes. If one identical twin has type 2 diabetes, there is a greater than 75 percent chance the other twin will have type 2 diabetes.

Type 1 Diabetes

If you have type 1 diabetes mellitus (T1DM), your body produces little or no insulin. Type 1 diabetes used to be called juvenile diabetes because it was usually diagnosed in childhood. An estimated 5 to 10 percent of Americans with diabetes have type 1 diabetes, which is a chronic disease. People with type 1 diabetes must take insulin every day.

The Mount Sinai Health System provides special services and classes for patients with T1DM as well as special instructions for those who are hospitalized.

In addition, our doctors and researchers are at the forefront in the development of the artificial pancreas, which is dramatically changing the lives of our patients with T1DM.

Type 2 Diabetes

Type 2 diabetes mellitus (T2DM) is a condition in which your body does not properly use insulin, does not produce enough insulin, or becomes resistant to normal levels of insulin. Type 2 diabetes is by far the most common type of diabetes and can sometimes be reversed with lifestyle changes. Your chances of developing type 2 diabetes increases as you get older. People with type 2 diabetes have to take pills and/or insulin.

At Mount Sinai, we provide specialized and individualized programs for our patients with T2DM to help you take control of your disease. From nutrition and exercise programs to personalized medication programs and continuous glucose monitoring, we empower you to manage your diabetes.

Prediabetes

Prediabetes occurs when your blood sugar levels are higher than normal but not high enough to indicate diabetes. An estimated 54 million Americans have prediabetes. Losing weight and making lifestyle changes such as eating healthier foods and exercising make it less likely that prediabetes will turn into diabetes.

Pre-diabetics and those at high risk for diabetes can prevent or delay onset of the disease with a mere 5 to 7 percent weight loss, if you are overweight. You can achieve this weight loss through dietand exercise/physical activity. The key is to set a weight loss goal that is SMART: Smart, Measurable, Attainable, Relevant, and Time-bound.

Physical Activity - Set achievable goals for yourself, especially if you are not used to being physically active. Here are some tips:

Team up with a friend.
Aim for 30 minutes of moderate-intensity aerobic activity five days a week. You can split this time into three 10-minute intervals.
Try a variety of exercise including swimming, biking, walking, running, and dancing.
Fit in little bits of exercise throughout the day. For instance, take the stairs when you can, get off the subway one stop early and walk to your destination, park further from store, do sit-ups at home during commercials if you’re watching television.
Incorporate moderate to high-intensity muscle strengthening activity at least two days a week in addition to the moderate exercise.

Diet - Making a series of small changes to the way you eat can have a big effect. Some suggestions include:

Decrease caloric consumption.
Keep a food diary.
Monitor portion sizes; your plate should consist of 1/2 non-starchy vegetables, 1/4 lean protein, 1/4 whole grain/high-fiber carbohydrates.
Choose unsaturated fats instead of saturated fats (i.e., nuts, olive oil, avocado instead of butter, full fat dairy products, red meat).
Choose lean proteins (i.e., boneless skinless chicken breasts and turkey cutlets).
Choose whole grains over refined grains (i.e., brown rice, whole wheat pasta instead of white rice, white pasta).
Limit yourself to 1 1/2 - 2 cups of fruit/day (one cup = one small apple, one large orange).
Increase non-starchy vegetable consumption.
Decrease sodium (less than 2300 mg/day) and substitute with herbs and seasonings.
Limit alcoholic beverages.
Limit juice, soda, candy, cake, cookies, and ice cream. Don’t fry foods. Instead: bake, grill, steam, or boil.

Know Your Numbers - It helps to keep track of how you are doing. Consider having your primary care physican check your cholesterol, blood pressure, and blood sugar every year. You should also discuss your concerns with your doctor if you have a family history of diabetes or think you may be at risk.

Unusual Forms of Diabetes

Hypoglycemia occurs when your blood sugar is below 70 mg/dL. The condition can stem from insulin/oral diabetes medications; skipped, delayed, or insubstantial meals; alcohol consumption; and/or physical activity. During a hypoglycemic episode, it is important to consume 15 grams of sugar in the form of 3 to 4 glucose tablets, 4 ounces of fruit juice or 6 ounces of soda, and then recheck blood glucose in 15 minutes to make sure it has risen above the 70 mg/dL threshold. Once blood sugars are back where they should be, at 70 mg/dL, you should have a meal or a snack, such as a small sandwich.

Latent autoimmune diabetes of adults (LADA) is a slow-developing condition has features of both type 1 and type 2 diabetes, so we also call it type 1.5. If you have LADA, you may not require insulin immediately when you are diagnosed, but you could develop a need for it over time. There are three types of LADA:

Type 1-LADA – autoantibodies. This type usually affects people who are not obese and they typically require insulin within five years.
Type 1.5 – autoimmune destruction of beta cells and insulin resistance. This condition generally affects people who are overweight or obese. They often require insulin within 5 to 10 years of diagnosis.
Type 2 diabetes with autoantibodies. This condition often affects people who are obese or overweight; they usually experience insulin resistance, but they produce autoantibodies and have mild autoimmunity. This group produces insulin for less than five years after diagnosis.

Maturity onset diabetes of the young (MODY) accounts for 1 to 2 percent of those diagnosed with diabetes. Caused by a change in a single gene, there is a 50 percent chance that the affected gene will be passed on and that MODY will develop before age 25. If you have MODY, you may not require insulin. There are several types of MODY and we treat each type differently, so it is important to know what kind of MODY you have. To identify MODY, we perform genetic testing and bloodwork.

Leptin deficiency stems from insufficient levels of leptin, a hormone produced by fat cells that influences feelings of hunger and energy expenditure. People who have leptin deficiency often experience obesity, excess levels of circulating insulin, and insulin resistance.