Your body takes care of countless tasks for you. You might not notice all it's doing until you need to manage diabetes.
More than 100 million Americans are living with diabetes or prediabetes, a condition where blood glucose levels are higher than normal, but not high enough to be considered diabetes. People with diabetes must frequently check their blood glucose (or blood sugar) and take quick action if it gets too high or low. They must also constantly consider how all meals, physical activity, and things like stress will affect their blood glucose.
Types of Diabetes
How people with diabetes manage their blood glucose levels depends, in part, on the type of diabetes they have. The most common are type 1, type 2, and gestational diabetes.
With type 1 diabetes, your body doesn’t make enough of a hormone called insulin. Insulin signals the body’s cells to let glucose inside. The body can’t produce enough insulin because the immune system, your body’s defense against germs and foreign substances, mistakenly attacks and destroys the cells in your pancreas that make insulin.
Type 2 diabetes is the most common. It occurs when either your body’s cells have trouble using insulin or your body doesn’t produce enough insulin to handle the glucose in your blood.
Both types can develop at any age. Type 1 is most often diagnosed in children and young adults, while type 2 shows up most in middle-age and older people. Gestational diabetes occurs only during pregnancy, but increases your chances of developing type 2 later in life.
Diabetes symptoms can vary by type. Some shared symptoms include increased thirst, hunger, and urination. Symptoms of type 1 can start quickly, over a few weeks. Type 2 symptoms tend to develop slowly over years, making them less noticeable.
Blood Glucose Control
Many people with diabetes check their blood glucose with a blood glucose meter. This portable machine measures how much glucose is in the blood. You get a drop of blood by pricking the side of your fingertip with a small, specialized needle. Then you apply the blood to a test strip. The meter shows you how much glucose is in your blood at that moment.
People with type 1 diabetes, and some people with type 2, correct and manage their blood glucose with injections of synthetic insulin. A missed, or miscalculated, dose can lead to serious complications, immediately and over time. Diabetes increases your risk for blindness, heart disease, stroke, kidney failure, and amputation.
“It’s a significant burden to self-test sugar levels several times a day, count carbohydrates with each meal, take into account the impact of physical activity, and then calculate the amount of insulin you need to inject multiple times a day with a syringe or the help of an insulin pump,” explains Dr. Guillermo Arreaza-Rubín, who heads NIH’s Diabetes Technology Program. Any error in this management may lead to life-threatening complications like severe hypoglycemia, which is very low blood glucose.
“Hypoglycemia is one of the main reasons people with type 1 visit hospital emergency rooms every day,” Arreaza-Rubín says. “It happens more frequently during the night and is a major cause of fear and anxiety among people with diabetes and their families.”
Help From Technology
NIH funded-scientists are testing promising technologies to help people better manage diabetes. For example, “artificial pancreas” systems monitor blood glucose levels and provide insulin, or a combination of insulin and another important hormone, automatically. The devices vary in how easy they are to set up and use.
“Our device, called the iLet, is designed to minimize the guesswork and time drain that comes with managing type 1 diabetes,” says Dr. Edward Damiano, a biomedical engineering expert at Boston University who’s co-founded a company to further develop the technology. The device only requires that you type in your body weight to get started. “The system does the heavy lifting of regulating blood glucose, freeing up the user to live a less burdened and more spontaneous life.”
Previous studies have shown that artificial pancreas systems can be safer than the current standard for insulin delivery. Several different devices are now being tested in more people for longer periods of time. Researchers are looking at safety, user-friendliness, the physical and emotional health of the participants, and cost.
Safety is a priority for researchers. “When people with type 1 exercise, their blood glucose can respond in unpredictable and potentially dangerous ways,” explains University of Virginia engineer Dr. Marc Breton. He led a recent study that showed an artificial pancreas system improved glycemic control and reduced hypoglycemia in adolescents with type 1 diabetes as they participated in winter sports, like skiing and snowboarding.
“The artificial pancreas performed very well in an extremely challenging environment,” he says. “Eventually, it may allow people with diabetes the freedom to participate safely in physical activities that they likely avoided in the past.”
One FDA-approved artificial pancreas is already available for people with diabetes. Devices that are more fully automated may become available to the public within the next couple years. Researchers are considering how to use these systems for people with type 2, gestational diabetes, and other conditions involving elevated blood glucose levels.
Other scientists are taking different approaches to replace insulin more effectively. For example, “smart insulins” would become active only when needed. Researchers are also looking for ways to regenerate or replace insulin-producing cells—and to stop the body from attacking them.
“These technologies will help make managing diabetes easier and will help make people who use them healthier,” says Damiano. “I see them as a bridge to a cure for type 1 diabetes.”
While future tools may make it easier to manage your diabetes, you can learn how to manage diabetes with the tools we have now to live a long, healthy life. Medications, glucose monitors, and insulin pumps are all available now to help people with diabetes. If you have diabetes, talk with your health care provider about your options.
Article written by: NIH Office of Communications and Public Liaison
Editor: Harrison Wein, Ph.D.
Managing Editor: Tianna Hicklin, Ph.D.
Illustrator: Alan Defibaugh