Clinical Guidelines

American Diabetes Association Diabetes Care

American Diabetes Clinical Guidelines 2


What is Diabetes?

Diabetes occurs when too much glucose builds up in the blood. The blood contains an amount of glucose in the body for energy, but too much glucose in the blood is unhealthy. Glucose is derived from food, as well as from the liver and muscles. The blood carries the glucose to all of the cells in the body. Insulin is a chemical (a hormone) made by the pancreas. The pancreas releases insulin into the blood which helps the glucose from food get into the body cells. If the body’s does not make enough insulin or if the insulin is not properly breaking glucose down, the blood glucose level gets too high, causing pre-diabetes or diabetes.


Pre-diabetes occurs when blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. People with pre-diabetes are at an increased risk for developing type 2 diabetes and for heart disease and stroke. People with prediabetes can reduce the risk of developing type 2 diabetes with weight loss, and increase physical activity.

Types of Diabetes

There are three main types of diabetes: type 1, type 2, and gestational diabetes. The result of type 1 and type 2 diabetes is the same: glucose builds up in the blood, while the cells are starved of energy. Over the years, high blood glucose damages nerves and blood vessels, oftentimes leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation.

Type 1 Diabetes

Type 1 diabetes, formerly called juvenile diabetes or insulin-dependent diabetes, is usually first diagnosed in children, teenagers, or young adults. With this form of diabetes, the beta cells of the pancreas no longer make insulin because the body’s immune system has attacked and destroyed them.

Type 2 Diabetes

Type 2 diabetes, formerly called adult-onset diabetes or non insulin-dependent diabetes, is the most common form of diabetes. Type 2 diabetes can be developed at any age, even in childhood. This form of diabetes usually begins with insulin resistance, a condition in which the body does not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals.

Gestational Diabetes

Some women develop gestational diabetes during the late stages of pregnancy. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin. Although this form of diabetes usually goes away after the baby is born, a woman or her child is likely to develop diabetes later in life. In fact, women who have had gestational diabetes have a 35% to 60% chance of developing diabetes in the next 10-20 years, according to the CDC.

Risk Factors

Type 1 Diabetes

Type 1 diabetes is an autoimmune disease. In an autoimmune reaction, antibodies, or immune cells, attach to the body’s own healthy tissues by mistake, signaling the body to attack them.

At present, scientists do not know exactly what causes the body’s immune system to attack the cells, but many believe that both genetic factors and environmental factors, such as viruses, are involved. Studies are now underway to identify these factors and prevent type 1 diabetes in people at risk.

Type 2 Diabetes

Type 2 diabetes is the most common form of diabetes. It is linked closely to being overweight, obesity, high blood pressure, and abnormal cholesterol levels. About 80 percent of people with type 2 diabetes are overweight. Being overweight can keep the body from using insulin properly.

Gestational Diabetes

Some women develop diabetes during the late stages of pregnancy. This is called gestational diabetes. Although this form of diabetes usually goes away after the baby is born, a woman who has had it has a lifelong risk for developing diabetes, mostly type 2

Signs and Diagnosis

Many people with diabetes experience one or more telling symptoms, including extreme thirst or hunger, a frequent need to urinate and/or fatigue. Some lose weight without trying. Additional signs include sores that heal slowly, dry, itchy skin, loss of feeling or tingling in the feet and blurry eyesight. Some people with diabetes, however, have no symptoms at all.

Symptoms can also be so mild that you don’t notice them. An estimated 7 million people in the United States have type 2 diabetes and don’t know it, according to 2011 estimates by the Centers for Disease Control and Prevention (CDC).

Common Signs

  • Some common symptoms of diabetes are:
  • being very thirsty
  • frequent urination
  • feeling very hungry or tired
  • losing weight without trying
  • having sores that heal slowly.
  • having dry, itchy skin
  • loss of feeling or tingling in the feet
  • having blurry eyesight.

Signs of type 1 diabetes usually develop over a short period of time. The signs for type 2 diabetes develop more gradually.

Tests for Diabetes

  • A fasting plasma glucose (FPG) test,-It measures blood glucose after at least 8 hours of fasting. Doctors use this test to detect diabetes or pre-diabetes.
  • An oral glucose tolerance test, or OGTT- It measures blood glucose after at least 8 hours of fasting and 2 hours after drinking a sweet beverage. Doctors also use the oral glucose tolerance test to diagnose gestational diabetes in pregnant women.
  •  An A1C –A1C measures average blood glucose levels over the past 3 months. It can be used to diagnose type 2 diabetes and pre-diabetes. It does not require fasting and blood can be drawn for the test any time of the day.
  • In a random plasma glucose test- The doctor checks your blood glucose without regard to when a person’s last meal was consumed. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes


The two most common forms of diabetes are type 1 and type 2. Currently, there is no way to delay or prevent type 1 diabetes. However, research has shown that type 2 diabetes can be prevented or delayed in people at risk for the disease. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes. Preventing type2 diabetes can mean a healthier and longer life without serious complications from the disease such as heart disease, stroke, blindness, kidney failure, and amputations.

Making modest lifestyle changes can often prevent or delay type2 diabetes in people who are at risk. Here are some tips.

  • Reach and maintain a reasonable body weight-Weight status affects health in many ways. Being overweight can keep the body from making and using insulin properly. It can also cause high blood pressure.
  • Make healthy food choices-Diet has a big impact on r weight and overall health. Developing healthy eating habits can help control body weight, blood pressure, and cholesterol. Reducing portion size, increasing fiber content (by eating more fruits and vegetables) and limiting fatty and salty foods are key to a healthy diet.
  • Get at least 30 minutes of exercise at least five days a weekRegular exercise reduces diabetes risk in several ways: it helps with weight loss, controls cholesterol and blood pressure, and improves the body’s use of insulin. Many people make walking part of their daily routine because it’s easy, fun and convenient. It is important to get in at least 30minutes of exercise every day.
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