WHEN SHOULD I WORRY ABOUT...

How Do You Know If You Have Diabetes?

Nov. 3, 2022 - Katie McCallum

Around 96 million adults have prediabetes — the predecessor to type 2 diabetes — but more than 80% don't know it, according to the CDC.

Nor is diabetes just an issue for adults. It's a rising threat to kids and teens as well. In fact, the CDC also says that 1 in 5 teens aged 12-18 years has prediabetes.

"The problem with type 2 diabetes is that it can progress silently over many years, so the diagnosis may be delayed until the blood sugars are very high and a person becomes very symptomatic," says Dr. Archana Sadhu, an endocrinologist at Houston Methodist. "Unfortunately, by that point, we've already missed the window of opportunity for early treatment and prevention of complications."

There is good news, though. Type 2 diabetes is preventable. And there are steps people can start taking today to keep prediabetes from progressing to diabetes.

How do you get diabetes?

Diabetes is a complex condition, and demystifying it starts with understanding the role of a hormone called insulin. It also includes clarifying what are type 1 and type 2 diabetes.

Insulin regulates the amount of glucose in your bloodstream, helping to store excess glucose you don't need right away. This is an important job since having too much sugar in the bloodstream can damage the vessels that supply your vital organs with blood.

Normally, the pancreas releases insulin as your blood glucose levels rise during and after a meal. But for people with type 1 and type 2 diabetes, insulin either isn't made or the body isn't effectively responding to it.

"With type 1 diabetes, the pancreas doesn't make any insulin," explains Dr. Sadhu. "The cells that produce it have been killed off by an autoimmune process. In prediabetes and type 2 diabetes, that's not the case. Insulin is being made, but the body is becoming — or has already become — resistant to it."

To compensate for insulin resistance, the pancreas has to start churning out more of the hormone — sometimes 5- to 10-fold more — just to keep blood sugar in a healthy range.

"This places a huge burden on the cells that make insulin," says Dr. Sadhu. "As insulin-producing cells continue to have to work harder, they get exhausted and die off. This reduces the body's ability to control blood sugar. And continuing to lose more of these cells only makes the problem worse."

In fact, by the time a person has prediabetes, 50% to 60% of these cells have died off, notes Dr. Sadhu.

Continued progression of the disease and the resulting inability to control blood sugar leads to blood vessel damage and stresses many organs, including the brain, heart, kidneys, eyes, nerves, liver and more. Such damage and stress leads to the complications associated with type 2 diabetes, such as kidney disease, cardiovascular disease and wound issues

As for what causes all of this to happen in the first place, type 2 diabetes risk factors include:

  • Genetics – having a family history of type 2 diabetes
  • Being overweight – exceeding the optimal weight for a person of your height, sex and age
  • A sedentary lifestyle – not being physically active enough
  • Poor diet – regularly eating processed foods full of refined carbohydrates and added sugars

"Ethnicity is also very important risk factor," says Dr. Sadhu. "The prevalence of type 2 diabetes varies by ethnicity significantly."

According to the CDC, your risk is higher if you are African American, Hispanic or Latino, American Indian or an Alaska Native.

What are the early signs of diabetes?

The signs of diabetes include:

  • Very frequent urination
  • Excessive thirst
  • Lack of energy
  • Unexplained weight loss
  • Blurred vision
  • Foot numbness, tingling and even pain

"The symptom people often notice first is more frequent urination," says Dr. Sadhu. "All of a sudden they're going to the restroom every hour, or even half hour, and waking up to go five or more times a night. It can cause pretty obvious and significant changes to a person's routine, which is easily recognized."

But Dr. Sadhu reminds us that, once these symptoms are noticed, type 2 diabetes has likely already developed — and that the disease course already has progressed beyond prediabetes.

"We want people to be aware of the signs of diabetes, but we also want them to know their risk factors and get tested well before symptoms develop," says Dr. Sadhu. "The earlier we intervene in the disease process, the more insulin-producing cells we can preserve and the easier it will be to normalize your blood sugar and prevent prediabetes from progressing."

How do you know if you have diabetes?

"The age criteria for diabetes screening has dropped, and it's now recommended that everyone over the age of 35 get tested for diabetes," says Dr. Sadhu. "If you're overweight or have a family history, you should be checked even sooner."

All that's needed is a simple blood test.

"A fasting blood glucose test helps determine how well your body is handling blood glucose metabolism," says Dr. Sadhu. "The other test used is called an A1C test, which provides a more long-term perspective since it gives an average of what your blood glucose has been over the last three months."

If you're having regular wellness exams, it's highly likely your primary-care doctor is using these blood tests to check for diabetes already — even if you're not yet 35. Still, it never hurts to ask your doctor to make sure.

Diabetes prevention: How to avoid diabetes

The best ways to avoid both prediabetes and type 2 diabetes is to engage in a healthy lifestyle by:

  • Choosing whole foods over processed foods
  • Staying active
  • Maintaining a healthy weight

"Regular screening is important, too — especially if you have risk factors — because if things are progressing, we want to catch the issue at prediabetes and take it seriously right away," says Dr. Sadhu. "That's the time to be aggressive since it's the stage when you can really change the trajectory of your type 2 diabetes risk."

Lifestyle interventions — long-term changes to the way you approach food, your weight and exercise — are critical.

(Related: Diabetes Diet Plan: What Are the Foods to Avoid With Diabetes?)

"By modifying your diet and getting more physical exercise, you can reduce your risk of prediabetes progressing to type 2 diabetes by up to 50%," adds Dr. Sadhu.

Also important: weight loss. In fact, dropping just 7% of your body weight can also help reduce your risk.

"A lot of this is within the person's control, but we're in this predicament because these lifestyle changes don't just happen overnight and they're not easy to make," adds Dr. Sadhu. "For those who cannot or are unable to accomplish those changes, we have great medications now that can be considered for weight loss and for diabetes-complication prevention."

The bottom line: Preventing prediabetes and diabetes is about living a healthy lifestyle. It is also about engaging in regular diabetes screening, which can identify your risk and guide any lifestyle adjustments you may need to make.

"I can't emphasize enough: Don't wait for the symptoms, be proactive for your health," adds Dr. Sadhu. "As they say, an ounce of prevention is worth a pound of cure."

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