PREVENTION

Can prediabetes, Type 2 diabetes and gestational diabetes be prevented?

Although diabetes risk factors like family history and race can’t be changed,
there are other risk factors that you do have some control over. Adopting
some of the healthy lifestyle habits listed below can improve these modifiable
risk factors and help to decrease your chances of getting diabetes:

 Eat a healthy diet, such as the Mediterranean or Dash diet. Keep a food
diary and calorie count of everything you eat. Cutting 250 calories per
day can help you lose ½ pound per week.
 Get physically active. Aim for 30 minutes a day at least five days a
week. Start slow and work up to this amount or break up these minutes
into more doable 10 minute segments. Walking is great exercise.
 Lose weight if you are overweight. Don’t lose weight if you are
pregnant, but check with your obstetrician about healthy weight gain
during your pregnancy.
 Lower your stress. Learn relaxation techniques, deep breathing
exercises, mindful meditation, yoga and other helpful strategies.
 Limit alcohol intake. Men should drink no more than two alcoholic
beverages a day; women should drink no more than one.
 Get an adequate amount of sleep (typically 7 to 9 hours).
 Quit smoking.
 Take medications – to manage existing risk factors for heart disease
(e.g., high blood pressure, cholesterol) or to reduce the risk of
developing Type 2 diabetes – as directed by your healthcare provider.
 If you think you have symptoms of prediabetes, see your provider.

Can Type 1 diabetes be prevented?

No. Type 1 diabetes is an autoimmune disease, meaning your body attacks

itself. Scientists aren’t sure why someone’s body would attack itself. Other
factors may be involved too, such as genetic changes.
Can the long-term complications of diabetes be prevented?
Chronic complications are responsible for most illness and death associated
with diabetes. Chronic complications usually appear after several years of
elevated blood sugars (hyperglycemia). Since patients with Type 2 diabetes
may have elevated blood sugars for several years before being diagnosed,
these patients may have signs of complications at the time of diagnosis.

The complications of diabetes have been described earlier in this article.

Although the complications can be wide ranging and affect many organ
systems, there are many basic principles of prevention that are shared in
common. These include:

 Take your diabetes medications (pills and/or insulin) as prescribed by

your doctor.
 Take all of your other medications to treat any risk factors (high blood
pressure, high cholesterol, other heart-related problems and other health
conditions) as directed by your doctor.
 Monitor your blood sugars closely.
 Follow a healthy diet, such as the Mediterranean or Dash diet. Do not
skip meals.
 Exercise regularly, at least 30 minutes five days a week.
 Lose weight if you are overweight.
 Keep yourself well-hydrated (water is your best choice).
 Quit smoking, if you smoke.
 See your doctor regularly to monitor your diabetes and to watch for
complications.

OUTLOOK / PROGNOSIS
What should I expect if I have been diagnosed with diabetes?

If you have diabetes, the most important thing you can do is keep your blood
glucose level within the target range recommended by your healthcare
provider. In general, these targets are:

 Before a meal: between 80 and 130 mg/dL.

 About two hours after the start of a meal: less than 180 mg/dL.
You will need to closely follow a treatment plan, which will likely include
following a customized diet plan, exercising 30 minutes five times a week,
quitting smoking, limiting alcohol and getting seven to nine hours of sleep a
night. Always take your medications and insulin as instructed by your
provider.

LIVING WITH
When should I call my doctor?

If you haven’t been diagnosed with diabetes, you should see your healthcare
provider if you have any symptoms of diabetes. If you already have been
diagnosed with diabetes, you should contact your provider if your blood
glucose levels are outside of your target range, if current symptoms worsen or
if you develop any new symptoms.
Does eating sugary foods cause diabetes?

Sugar itself doesn't directly cause diabetes. Eating foods high in sugar content
can lead to weight gain, which is a risk factor for developing diabetes. Eating
more sugar than recommended – American Heart Association recommends
no more than six teaspoons a day (25 grams) for women and nine teaspoons
(36 grams) for men – leads to all kinds of health harms in addition to weight
gain.

These health harms are all risk factors for the development of diabetes or can
worsen complications. Weight gain can:

 Raise blood pressure, cholesterol and triglyceride levels.

 Increase your risk of cardiovascular disease.
 Cause fat buildup in your liver.
 Cause tooth decay.
What types of healthcare professionals might be part of my diabetes treatment
team?

Most people with diabetes see their primary healthcare provider first. Your
provider might refer you to an endocrinologist/pediatric endocrinologist, a
physician who specializes in diabetes care. Other members of your healthcare
team may include an ophthalmologist (eye doctor), nephrologist (kidney
doctor), cardiologist (heart doctor), podiatrist (foot doctor), neurologist
(nerve and brain doctor), gastroenterologist (digestive tract doctor), registered
dietician, nurse practitioners/physician assistants, diabetes educator,
pharmacist, personal trainer, social worker, mental health professional,
transplant team and others.
How often do I need to see my primary diabetes healthcare professional?

In general, if you are being treated with insulin shots, you should see your
doctor at least every three to four months. If you are treated with pills or are
managing diabetes through diet, you should be seen at least every four to six
months. More frequent visits may be needed if your blood sugar is not
controlled or if complications of diabetes are worsening.
Can diabetes be cured or reversed?

Although these seem like simple questions, the answers are not so simple.
Depending on the type of your diabetes and its specific cause, it may or may
not be possible to reverse your diabetes. Successfully reversing diabetes is
more commonly called achieving “remission.”

Type 1 diabetes is an immune system disease with some genetic component.

This type of diabetes can’t be reversed with traditional treatments. You need
lifelong insulin to survive. Providing insulin through an artificial pancreas
(insulin pump plus continuous glucose monitor and computer program) is the
most advanced way of keeping glucose within a tight range at all times –
most closely mimicking the body. The closest thing toward a cure for Type 1
is a pancreas transplant or a pancreas islet transplant. Transplant candidates
must meet strict criteria to be eligible. It’s not an option for everyone and it
requires taking immunosuppressant medications for life and dealing with the
side effects of these drugs.

It’s possible to reverse prediabetes and Type 2 diabetes with a lot of effort

and motivation. You’d have to reverse all your risk factors for disease. To do
this means a combination of losing weight, exercising regularly and eating
healthy (for example, a plant-based, low carb, low sugar, healthy fat diet).
These efforts should also lower your cholesterol numbers and blood pressure
to within their normal range. Bariatric surgery (surgery that makes your
stomach smaller) has been shown to achieve remission in some people with
Type 2 diabetes. This is a significant surgery that has its own risks and
complications.

If you have gestational diabetes, this type of diabetes ends with the birth of
your child. However, having gestational diabetes is a risk factor for
developing Type 2 diabetes.

The good news is that diabetes can be effectively managed, treated and
controlled. The extent to which your Type 1 or Type 2 diabetes can be
controlled is a discussion to have with your healthcare provider.
Can diabetes kill you?

Yes, it’s possible that if diabetes remains undiagnosed and uncontrolled

(severely high or severely low glucose levels) it can cause devastating harm
to your body. Diabetes can cause heart attack, heart failure, stroke, kidney
failure and coma. These complications can lead to your death. Cardiovascular
disease in particular is the leading cause of death in adults with diabetes.

FREQUENTLY ASKED QUESTIONS

How does COVID-19 affect a person with diabetes?

Although having diabetes may not necessarily increase your risk of

contracting COVID-19, if you do get the virus, you are more likely to have
more severe complications. If you contract COVID-19, your blood sugars are
likely to increase as your body is working to clear the infection. If you
contract COVID-19, contact your healthcare team early to let them know.
How does diabetes affect your heart, eyes, feet, nerves and kidneys?

Blood vessels are located throughout our body’s tissues and organs. They
surround our body’s cells, providing a transfer of oxygen, nutrients and other
substances, using blood as the exchange vehicle. In simple terms, diabetes
doesn’t allow glucose (the body’s fuel) to get into cells and it damages blood
vessels in/near these organs and those that nourish nerves. If organs, nerves
and tissues can’t get the essentials they need to properly function, they can
begin to fail.“Proper function” means that your heart’s blood vessels,
including arteries, are not damaged (narrowed or blocked). In your kidneys,
this means that waste products can be filtered out of your blood. In your eyes,
this means that the blood vessels in your retina (area of your eye that
provides your vision) remain intact. In your feet and nerves, this means that
nerves are nourished and that there’s blood flow to your feet. Diabetes causes
damage that prevents proper function.
How does diabetes lead to amputation?

Uncontrolled diabetes can lead to poor blood flow (poor circulation). Without
oxygen and nutrients (delivered in blood), you are more prone to the
development of cuts and sores that can lead to infections that can’t fully heal.
Areas of your body that are farthest away from your heart (the blood pump)
are more likely to experience the effects of poor blood flow. So areas of your
body like your toes, feet, legs and fingers are more likely to be amputated if
infection develops and healing is poor.
Can diabetes cause blindness?

Yes. Because uncontrolled diabetes can damage the blood vessels of the
retina, blindness is possible. If you haven’t been diagnosed with diabetes yet
but are experiencing a change in your vision, see primary healthcare provider
or ophthalmologist as soon as you can.
Can diabetes cause hearing loss?

Scientists don’t have firm answers yet but there appears to be a correlation
between hearing loss and diabetes. According to the American Diabetes
Association, a recent study found that hearing loss was twice as common in
people with diabetes versus those who didn’t have diabetes. Also, the rate of
hearing loss in people with prediabetes was 30% higher compared with those
who had normal blood glucose levels. Scientists think diabetes damages the
blood vessels in the inner ear, but more research is needed.
Can diabetes cause headaches or dizziness?

Yes, it’s possible to develop headaches or dizziness if your blood glucose

level is too low – usually below 70 mg/dL. This condition is called
hypoglycemia. You can read about the other symptoms hypoglycemia causes
in this article.Hypoglycemia is common in people with Type 1 diabetes and
can happen in some people with Type 2 diabetes who take insulin (insulin
helps glucose move out of the blood and into your body’s cells) or
medications such as sulfonylureas.
Can diabetes cause hair loss?

Yes, it’s possible for diabetes to cause hair loss. Uncontrolled diabetes can
lead to persistently high blood glucose levels. This, in turn, leads to blood
vessel damage and restricted flow, and oxygen and nutrients can’t get to the
cells that need it – including hair follicles. Stress can cause hormone level
changes that affect hair growth. If you have Type 1 diabetes, your immune
system attacks itself and can also cause a hair loss condition called alopecia
areata.
What types of diabetes require insulin?

People with Type 1 diabetes need insulin to live. If you have Type 1 diabetes,
your body has attacked your pancreas, destroying the cells that make insulin.
If you have Type 2 diabetes, your pancreas makes insulin, but it doesn’t work
as it should. In some people with Type 2 diabetes, insulin may be needed to
help glucose move from your bloodstream to your body’s cells where it’s
needed for energy. You may or may not need insulin if you have gestational
diabetes. If you are pregnant or have Type 2 diabetes, your healthcare
provider will check your blood glucose level, assess other risk factors and
determine a treatment approach – which may include a combination of
lifestyle changes, oral medications and insulin. Each person is unique and so
is your treatment plan.
Can you be born with diabetes? Is it genetic?

You aren’t born with diabetes, but Type 1 diabetes usually appears in
childhood. Prediabetes and diabetes develop slowly over time – years.
Gestational diabetes occurs during pregnancy.Scientists do believe that
genetics may play a role or contribute to the development of Type 1 diabetes.
Something in the environment or a virus may trigger its development. If you
have a family history of Type 1 diabetes, you are at higher risk of developing
Type 1 diabetes. If you have a family history of prediabetes, Type 2 diabetes
or gestational diabetes, you’re at increased risk of developing prediabetes,
Type 2 diabetes or gestational diabetes.
What is diabetic ketoacidosis?

Diabetic ketoacidosis is a life-threatening condition. It happens when your

liver breaks down fat to use as energy because there’s not enough insulin and
therefore glucose isn’t being used as an energy source. Fat is broken down by
the liver into a fuel called ketones. The formation and use of ketones is a
normal process if it has been a long time since your last meal and your body
needs fuel. Ketones are a problem when your fat is broken down too fast for
your body to process and they build up in your blood. This makes your blood
acidic, which is a condition called ketoacidosis. Diabetic ketoacidosis can be
the result of uncontrolled Type 1 diabetes and less commonly, Type 2
diabetes.Diabetic ketoacidosis is diagnosed by the presence of ketones in
your urine or blood and a basic metabolic panel. The condition develops over
several hours and can cause coma and possibly even death.
What is hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?

Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) develops more

slowly (over days to weeks) than diabetic ketoacidosis. It occurs in patients
with Type 2 diabetes, especially the elderly and usually occurs when patients
are ill or stressed.If you have HHNS, you blood glucose level is typically
greater than 600 mg/dL. Symptoms include frequent urination, drowsiness,
lack of energy and dehydration. HHNS is not associated with ketones in the
blood. It can cause coma or death. You’ll need to be treated in the hospital.
What does it mean if test results show I have protein in my urine?

This means your kidneys are allowing protein to be filtered through and now
appear in your urine. This condition is called proteinuria. The continued
presence of protein in your urine is a sign of kidney damage.

A note from Cleveland Clinic

There’s much you can do to prevent the development of diabetes (except

Type 1 diabetes). However, if you or your child or adolescent develop
symptoms of diabetes, see your healthcare provider. The earlier diabetes is
diagnosed, the sooner steps can be taken to treat and control it. The better you
are able to control your blood sugar level, the more likely you are to live a
long, healthy life.