Making sense of diabetes, together

Diabetes is a long-term condition in which the body cannot properly control the level of sugar (glucose) in the blood. This happens either because the pancreas does not make enough insulin or because the body cannot use insulin well.

There are several types, mainly type 1, type 2 and gestational diabetes. Diabetes cannot usually be cured, but it can be managed very effectively with medicine, food choices, activity and regular monitoring.

No, diabetes is not contagious.

You cannot catch diabetes from someone else or pass it on by touching, sharing food or being close. Type 1 diabetes is an autoimmune condition, and type 2 diabetes develops from a mix of genetics, weight, age and lifestyle. Diabetes can run in families because of shared genes, not because it spreads.

Both cause high blood sugar, but the causes and treatments differ.

Some people are diagnosed with one type and later found to have another, such as latent autoimmune diabetes in adults (LADA), so testing matters.

The cause depends on the type of diabetes:

• Type 1: the immune system destroys the insulin-making beta cells in the pancreas. Genes and an environmental trigger are thought to play a role, but it is not caused by diet or lifestyle.
• Type 2: the body becomes resistant to insulin and eventually cannot make enough to keep up. Genetics, excess weight (especially around the waist), inactivity, age and other factors contribute.
• Gestational: hormones during pregnancy make it harder for the body to use insulin. It usually resolves after birth but raises the future risk of type 2.
• Other causes: certain medicines, pancreatic disease and rare genetic forms can also cause diabetes.

Diabetes is not caused by eating too much sugar alone, and it is not your fault.

Common early signs include increased thirst, needing to urinate more often, feeling tired, blurred vision, slow-healing cuts, frequent infections and, in type 1, unexplained weight loss.

Type 2 diabetes often develops so slowly that people have no symptoms for years, which is why screening is recommended for adults at higher risk. If you notice these signs, ask your doctor for a blood test.

Prediabetes means your blood sugar is higher than normal but not high enough for a diabetes diagnosis, typically an HbA1c of 5.7 to 6.4 percent. It is a warning sign that type 2 diabetes may develop.

The encouraging part is that it can often be turned around. Losing a modest amount of weight, being more active and eating a balanced diet can bring blood sugar back to normal and prevent or delay type 2 diabetes. Your doctor may also suggest medicine such as metformin in some cases.

Type 1 diabetes cannot currently be cured, and people with it will always need insulin.

Type 2 diabetes can go into remission in some people, meaning blood sugar returns to the non-diabetic range without medicine, most often after substantial weight loss, particularly soon after diagnosis. Remission is not a permanent cure, so regular check-ups are still important, and the diabetes can return.

There is no single diabetes diet, and you do not have to give up the foods you love. Most guidance focuses on a balanced eating pattern:

• Plenty of non-starchy vegetables, fruit in sensible portions and whole grains
• Lean protein, fish, beans and healthy fats such as olive oil, nuts and seeds
• Steady, moderate carbohydrate portions spread through the day
• Fewer sugary drinks, sweets and highly processed foods

A registered dietitian can build a plan around your medicines, culture, budget and preferences.

If you are conscious and your blood sugar is below about 70 mg/dL (3.9 mmol/L) or you have symptoms of a low, take 15 grams of fast-acting carbohydrate, such as glucose tablets, a half cup of juice or regular soda, or a tablespoon of honey. Recheck after 15 minutes and repeat if still low, then have a snack or meal once back in range.

If someone is confused, too drowsy to swallow or has a seizure, do not give food or drink. Use emergency glucagon if available and call emergency services.