Diabetes or diabetes mellitus is a group of metabolic diseases that occurs when the blood glucose (or blood sugar) is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. With diabetes, your body doesn’t make enough insulin or cannot use it effectively. Thus causing glucose to not reach the cells where it is required.
There are 3 common types of diabetes:
1. Type 1 diabetes
2. Type 2 diabetes
3. Gestational diabetes

Type 1 diabetes
When the immune system destroys insulin making cells (beta cells) in your pancreas. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age.
There is also a condition called secondary diabetes which is similar to type 1 diabetes, but the beta cells are wiped out by something else like a disease or an injury to your pancreas and not the immune system.

Causes
Type 1 diabetes occurs as the body's own immune system which normally fights harmful bacteria and viruses starts to destroy the insulin-producing (islet, or islets of Langerhans) cells in the pancreas. Other possible causes include:
• Genetics
• Exposure to viruses and other environmental factors

Risk factors:
• Family history. Anyone with a parent or sibling with type 1 diabetes has a slightly increased risk of developing the condition.
• Genetics. The presence of certain genes indicates an increased risk of developing type 1 diabetes.
• Geography. The incidence of type 1 diabetes tends to increase as you travel away from the equator.
• Age. Although type 1 diabetes can appear at any age, it appears at two noticeable peaks. The first peak occurs in children between 4 and 7 years old, and the second is in children between 10 and 14 years old.

Treatment:
People who have type 1 diabetes can live long, healthy lives as long as they keep monitoring their blood sugar level and keep it in the range required. They will have to adjust their insulin, food, and activities as necessary. Everyone with type 1 diabetes needs to use insulin shots to control their blood sugar.
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Types of insulin:
• Rapid-acting starts to work in about 15 minutes. It peaks about 1 hour after you take it and continues to work for 2 to 4 hours.
• Regular or short-acting starts to work in about 30 minutes. It peaks between 2 and 3 hours and keeps working for 3 to 6 hours.
• Intermediate-acting won’t get into your bloodstream for 2 to 4 hours after your shot. It peaks from 4 to 12 hours and works for 12 to 18 hours.
• Long-acting takes several hours to get into your system and lasts about 24 hours.

Type 2 diabetes
Type 2 diabetes is the most common type of diabetes. It occurs when the body does not make or use insulin well, that is, it becomes resistant to insulin and sugar builds up in your body. It can be developed at any age, even during childhood. However, this type of diabetes occurs most often in middle-aged and older people. Some people are also diagnosed with Pre-diabetes which occurs when your blood sugar is higher than normal, but it’s not high enough for a diagnosis of type 2 diabetes.

Causes
• Genes: Scientists have found different bits of DNA that affect how your body makes insulin.
• Extra weight: Being overweight or obese can cause insulin resistance, especially if you carry your extra pounds around your stomach.
• Metabolic syndrome: People with insulin resistance often have a group of conditions including high blood sugar, extra fat around the waist, high blood pressure, and high cholesterol and triglycerides.
• Too much glucose from your liver: When your blood sugar is low, your liver makes and sends out glucose. After you eat, your blood sugar goes up, and your liver will usually slow down and store its glucose for later. But some people's livers don't. They keep cranking out sugar.
• Bad communication between cells: Sometimes, cells send the wrong signals or don't pick up messages correctly. When these problems affect how your cells make and use insulin or glucose, a chain reaction can lead to diabetes.
• Broken beta cells: If the cells that make insulin send out the wrong amount of insulin at the wrong time, your blood sugar gets thrown off. High blood sugar can damage these cells, too.

Risk Factors
• Age: 45 or older
• Family: A parent, sister, or brother with diabetes
• Ethnicity: African American, Alaska Native, Native American, Asian American, Hispanic or Latino, or Pacific Islander American
Risk factors related to your health and medical history include Pre-diabetes, heart and blood vessel disease, high blood pressure, low HDL ("good" cholesterol, high triglycerides, overweight or obese, having a baby who weighed more than 9 pounds, gestational diabetes while you were pregnant, Polycystic ovary syndrome (PCOS) and depression.
Less exercise, smoking, stress and less sleep can also be causes of type 2 diabetes.

Treatment
Insulin is not required for every patient of type 2 diabetes. If insulin is required, that means that the pancreas is not making enough insulin on its own. Insulin should be taken if required, as prescribed by the doctor. There are some other medicines that your doctor may prescribe too.
• Include foods rich in fibre and healthy carbohydrates in your diet. Eating fruits, vegetables, and whole grains will help keep your blood glucose levels steady.
• Eat at regular intervals.
• Control your weight and keep your heart healthy. That means keeping refined carbohydrates, sweets, and animal fats to a minimum.
• Exercise to stay healthy.

Gestational diabetes
Gestational diabetes occurs when the blood sugar level gets high during pregnancy. Most of the time, this type of diabetes goes away after the baby is born. However, having gestational diabetes may make the risk of developing Type 2 diabetes higher. Sometimes diabetes diagnosed during pregnancy is actually type 2 diabetes.

Causes
The exact cause of gestational diabetes is unknown, but hormones likely play a role. When you’re pregnant, your body produces larger amounts of some hormones, including:
• Human placental lactogen (hPL)
• Hormones that increase insulin resistance
These hormones may cause glucose to build up in the blood. Usually, the pancreas can send out enough insulin to handle it. But if the body can’t make enough insulin or stops using insulin like it should, the blood sugar levels rise, and gestational diabetes occur.

Risk Factors
The risk of having gestational diabetes increases when a person:
• Is overweight or obese before pregnancy.
• Is pre-diabetic.
• Has family history of diabetes.
• Has had gestational diabetes with a previous pregnancy.
• Has high blood pressure or other medical complications.
• Has given birth to a baby weighing more than 9 pounds.
• Has given birth to a baby who was stillborn or had certain birth defects.
• Is over the age of 25.
• Has been on glucocorticoids.
• Has polycystic ovary syndrome (PCOS), Acanthosis nigricans, or other conditions that are associated with insulin resistance.
• Has African, Native American, Asian, Pacific Islander, or Hispanic ancestry.
• Is expecting multiple babies.

Treatment
The treatment plan for gestational diabetes depends on the blood sugar level.
In most cases, the doctor advises patients to test their blood sugar before and after meals, and manage their condition by eating healthy and exercising regularly. However, in some cases insulin injections are also needed until the baby is born.
A balanced diet is also important to maintain your blood sugar levels.

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Diagnosis of Diabetes:
For type 1 and type 2 diabetes:
1. Glycated hemoglobin (A1C) test: This blood test does not require fasting and indicates the average blood sugar level for the past two to three months.
2. Random blood sugar test: A blood sample is taken at a random time regardless of last consumption of food.
3. Fasting blood sugar test: A blood sample will be taken after an overnight fast.
4. Oral glucose tolerance test: This test requires fasting overnight and then the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours.
5. Another test called the Fructosamine test is also done at times to monitor and control their blood glucose levels in cases where the HbA1c test cannot be used and or if the patient only needs a short term monitoring. It reflects the average glucose levels over 2 to 3 weeks. If a person has diabetes, the glucose level ranges from 175 to 280 mmol/L. With controlled diabetes it ranges from 210 to 421 mmol/L and with uncontrolled diabetes it ranges from 268 to 870 mmol/L.

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For Gestational Diabetes:
The tests for gestational diabetes depend on your risk of having it. If the risk is more, the test for gestational diabetes will be done at the start of your pregnancy. If the risk is average, a screening test will be done in the second semester (24-28 weeks).
• Initial glucose challenge test: You will be given a syrupy glucose solution and tested an hour later. A blood sugar level below 140 mg/dL (7.8 mmol/L) is usually considered normal on a glucose challenge test, although this may vary at specific clinics or labs. If it is higher than that, then it only means you have a higher risk of gestational diabetes and will need a follow-up test to determine if you have gestational diabetes.
• Follow-up glucose tolerance testing: For the follow-up test, you'll be asked to fast overnight and then have your fasting blood sugar level measured. Then you'll drink another sweet solution (containing higher concentration of glucose than before) and your blood sugar level will be checked every hour for a period of three hours.
If at least two of the blood sugar readings are higher than the normal values established for each of the three hours of the test, you'll be diagnosed with gestational diabetes.
Health problems associated with diabetes

Over time, high blood glucose leads to problems such as: