• Type 1 (or juvenile) diabetesaccounts for 5 percent of all cases.
• Type 2 (or late onset) diabetes mellitus accounts for 95 percent of all cases.

Both types of diabetes affect the body’s ability to make or use insulin. Insulin is a hormone that controls the metabolism of sugar and fat in the body. It stimulates glucose uptake by cells and lipid synthesis, plus it inhibits the breakdown of lipids, proteins, and glycogen, and inhibits the production of glucagon and ketones.

Can Type 1 Diabetes Be Cured?

Type 1 diabetes is an autoimmune disease in which the immune system attacks the pancreas, reducing the body’s ability to make insulin. It develops most commonly in children and young adults and is a lifelong condition. There is currently no cure for type 2 diabetes. Treatment focuses on insulin replacement for life.

Can Type 2 Diabetes Be Cured?

Currently, type 2 diabetes cannot be “cured,” but some sufferers can go into remission for a period of time, meaning that their blood sugar is in the normal range. The underlying condition remains, however, and the individual is always at risk of relapse. In the rest of this article we’ll be talking about type 2 diabetes.

Types 2 Diabetes Complications

Type 2 diabetes is due to decreased insulin sensitivity and the body not making enough insulin. This results in high blood sugar (hyperglycemia) and abnormal lipid levels in blood.

If left untreated, diabetes damages cells, organs, and systems in the body leading to a whole host of problems, including:

• Cardiovascular disease
• Stroke
• Nerve damage (neuropathy)
• Kidney damage (nephropathy)
• Eye damage (retinopathy)
• Foot damage (including ulcers and gangrene)
• Skin infections
• Hearing impairment
• Increased risk of Alzheimer’s disease
• Depression

These complications lead to an increased risk of premature death.

What Causes Type 2 Diabetes?

In order to reduce symptoms and possibly trigger remission, it’s important to understand what causes diabetes. According to experts at National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the cause of type 2 diabetes mellitus is a complex interaction between environmental and genetic factors, including:

• Obesity (about 90 percent of those with type 2 diabetes are obese)
• Family history of diabetes
• High-calorie diet
• Inadequate exercise
• History of hypertension, prehypertension, heart disease, or stroke
• Age 45 or older
• Race (African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander’s are at increased risk.)
• High level of triglycerides (“bad” fats) and low levels of HDL (good fats)
• History of gestational diabetes or have given birth to a baby weighing 9 pounds or more.

How Lifestyle Changes Affect Diabetes

While family history, age, and race can’t be changed, lifestyle changes can:

• Reduce the risk of developing the disease
• Reduce the impact in existing disease
• Trigger a long-lasting remission

Sufferers will need to monitor blood sugar levels daily and also monitor symptoms, cholesterol, and weight regularly.

Diabetes: Diet Considerations

A healthy diet may help return and maintain blood glucose level to the normal range.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and many other physician groups recommend eating a variety of foods from all food groups: non-starchy vegetables, starchy vegetables, fruits, whole grains, lean protein, healthy fats, and dairy. They recommend portion control and calorie counting, and also limiting the following:

• Foods rich in saturated fat and trans fat
• Foods high in salt
• Foods rich in sugar and refined carbohydrates, such as baked goods, candy, and ice cream
• Drinks containing added sugars, such as soda, juice, sports drinks, or energy drinks

The NIDDK also recommends “carbohydrate counting”—that is, keeping track of what you eat. If you’re looking for a diet to follow, a Mediterranean-style eating plan or DASH diet have been extensively researched and shown to improve health.

A 2017 article in the journal Diabetes Care explains that the goals for dietary change should be “healthful eating patterns emphasizing a variety of nutrient-dense foods in appropriate portion sizes.” Additional goals include achieving a healthy weight; attaining healthy blood sugar, blood pressure, and lipid levels; and reducing complications. The authors emphasize developing an individualized plan based on “personal and cultural preferences, health literacy and numeracy, access to healthful foods, willingness and ability to make behavioral changes, and barriers to change.”

Some research, however, suggests a more drastic dietary change. A 2017 literature review concluded that “whole-foods, plant-based diet—legumes, whole grains, fruits, vegetables, and nuts, with limited or no intake of refined foods and animal products—are highly beneficial for preventing and treating type 2 diabetes.” A 2018 study found that overweight people who switched to a vegan diet for 16 weeks showed improvements in insulin sensitivity compared to a control group.

Other experts, including Dr. Mark Hyman, the Medical Director at Cleveland Clinic’s Center for Functional Medicine, recommend the restriction of dietary sugar and processed foods. In his book The Blood Sugar Solution, Dr. Hyman lays out a strategy—changing diet and improving nutrition—that has helped many people control diabetes.

Exercise: Key to Prevention and Treatment of Diabetes

Research has shown that physical activity combined with modest weight loss can reduce the risk for type 2 diabetes by up to 58 percent.

Physical activity increases energy/glucose use. A structured exercise programs of at least eight weeks has been shown to improve blood sugar control. Exercise also reduces body mass index (BMI), improves cardiovascular fitness, enhances muscle strength, and improves insulin sensitivity and mobility.

The U.S. Department of Health and Human Services recommends that adults “engage in 150 minutes per week of moderate-intensity or 75 minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination of the two. Additional recommendation: muscle-strengthening activities that involve all major muscle groups two or more days per week.

Always see your doctor when starting a new exercise problem if you have medical problems; he or she will advise you on what is safe and what to avoid. You also will need to drink plenty of water and monitor your blood sugar more closely, as exercise may impact its control.

Sedentary time should also be reduced for people with diabetes: Try some light movements such as standing or walking or even doing chores every 30 minutes or so.

Weight Loss

The combination of diabetes and excess body weight puts individuals at high risk of complications. For people who are overweight or obese, a five percent reduction in body weight has been shown to improve glycemic control, lipids and blood pressure and to reduce the need for medication. Weight loss always sound easy: Just eat less and exercise more. If only it were that simple! There are numerous reasons why people struggle to lose weight including mindset, practical problems (like a busy lifestyle or limited access to healthy food) and stress eating. Many benefit from joining a support group, advice from a dietician or using online tracking applications such as the Body
Weight Planner or the SuperTracker.

Gastric band and gastric bypass surgery may be useful for people who have been unable to lose weight, despite a concerted effort. As with any surgery there are risks involved, so it is not a first-line treatment.

Is There a Cure for Diabetes? A Future Play

While there is currently no cure for diabetes, researchers are hopeful for advancements. A 2017 pilot study may provide hope for a diabetes cure in the future. Researchers found that an intensive metabolic intervention, combining personalized exercise routines, strict diet, and glucose-controlling drugs could achieve partial or complete remission in 40 percent of patients, who were then able to stop their medication. More comprehensive studies are in the pipeline.

General advice to people with diabetes: Stop smoking, seek psychological support if needed, keep up to date with immunizations, and treat complications promptly.

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To avoid becoming part of the statistics, it’s vital to understand what causes diabetes and what you can do to reduce your risk.

Disappointing Diabetes Trends

At the 2011 United Nations High-Level Meeting on Non-Communicable Diseases, health experts set a challenging goal: Control diabetes so that by 2025, the worldwide prevalence of the disease remains at 2010 levels. Five years later, we’re no closer to reaching that goal, suggests a study published online in The Lancet (April 6, 2016).

Researchers analyzed 751 studies including more than 4.3 million adults in 146 countries. They calculated that from 1980 to 2014, the number of adults with diabetes worldwide nearly quadrupled, from 108 million in 1980 to 422 million in 2014. Although the prevalence of diabetes was higher in women in 1980, the 2014 data show that more men (nearly one in 10) now have diabetes.

Overall, the prevalence of diabetes in adults has risen or remained the same in every country, according to the study. The study authors noted that if the disappointing trends in diabetes prevalence continue, the probability of meeting the United Nations’ goal by 2025 is only 1 percent for women and less than 1 percent for men.

So, How Do You Get Diabetes?

The study findings only reinforce the importance of understanding what causes type 2 diabetes and how to prevent the disease.

Type 2 diabetes is the most common form of diabetes. Your body uses glucose (blood sugar) as a vital source of energy for your cells, and your pancreas creates insulin to regulate blood-glucose levels. In type 2 diabetes, your cells fail to use insulin properly—a condition known as insulin resistance—resulting in a rise in blood sugar.

In type 1 diabetes, a wayward immune response damages cells in the pancreas responsible for insulin production. Consequently, the pancreas does not produce adequate amounts of insulin to control blood sugar. Another form of diabetes, gestational diabetes, occurs in pregnant women because placental hormones that help a baby develop causes insulin resistance in the mother’s body, resulting in high blood sugar levels.

The key risk factor for type 2 diabetes—and the major factor behind the rising global prevalence of diabetes—is obesity. In fact, nearly nine out of 10 people with type 2 diabetes are overweight or obese, according to the Obesity Society. A sedentary lifestyle, which contributes to obesity, also is linked with increased type 2 diabetes risk.

Medical experts have developed several ways to measure obesity and thus gauge your risk of diabetes, heart disease, and other chronic conditions:

• Body mass index (BMI): To calculate your BMI, divide your weight in pounds by your height in inches squared and multiply by a factor of 703. For example, a 6-foot-tall, 200-pound man would have a BMI of 27.1. (Visit the National Heart, Lung and Blood Institute’s BMI calculator.) A BMI of 18.5–24.9 is considered healthy, 25–29.9 is overweight, and 30 or more is obese.
• Waist circumference: Wrap a tape measure around your bare abdomen at the level of your navel. A waist circumference of more than 40 inches for men and more than 35 inches for women indicates an increased risk of type 2 diabetes as well as heart disease.
• Waist-to-height ratio: A comparison of your waist circumference to your height. Your waist circumference in inches should be less than half your height in inches.
• Waist-to-hip ratio: Measure your waist around the narrowest spot between your hips and ribs after exhaling. With your heels together, measure your hips around the widest part of your buttocks. Divide your waist circumference by your hip measurement. Aim for a waist-to-hip ratio of less than 0.95 for men and 0.80 for women.

However, not all people who are overweight or obese develop type 2 diabetes, and some who have type 2 diabetes are not obese. So, it’s clear that other factors also contribute to type 2 diabetes risk, including advancing age, family history of type 2 diabetes, and ethnicity (the risk of type 2 diabetes is higher among African-Americans, Hispanics, Asian-Americans, and Native Americans). High blood pressure and lipid abnormalities (low HDL “good” cholesterol and high levels of triglycerides) also have been associated with an increased risk of type 2 diabetes.

Visit the American Diabetes Association’s My Health Advisor to calculate your odds of having diabetes, as well as your risk of heart disease and stroke.

And, most importantly, discuss your risk of diabetes with your physician, and work with your healthcare team to optimize any modifiable risk factors through diet, exercise, and, if necessary, medical therapy.

Originally posted in 2016, this post is regularly updated.

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But with prediabetes symptoms, they aren’t a reliable indicator of your condition because most of the time prediabetes offers up no telltale warning signs. Once you do experience symptoms, there’s a good chance you’ve already progressed to type 2 diabetes.

To thwart this progression and safeguard your cardiovascular health, take action now by changing your lifestyle, improving your overall health (a diabetic diet will help), and, if necessary, following your doctor’s recommendations regarding medical therapy.

Prediabetes Symptoms Are Silent

Some 15 to 30 percent of people with prediabetes symptoms progress to type 2 diabetes within five years if they fail to make appropriate lifestyle changes, according to the Centers for Disease Control and Prevention (CDC).

Prediabetes and type 2 diabetes are diagnosed based on the following test results:

Test Results to Diagnose Prediabetes

• Fasting glucose test: 100–125 milligrams per deciliter (mg/dL)
• Oral glucose tolerance test: 140–199 mg/dL
• Hemoglobin A1c: 5.7–6.4 percent

Test Results to Diagnose Type 2 Diabetes

• Fasting glucose test: 126 mg/dL or higher
• Oral glucose tolerance test: 200 mg/dL or higher
• Hemoglobin A1c: 6.5 percent or higher

Trouble is, unless you see your doctor and get tested, there’s no way to know for certain if you’re on the path to type 2 diabetes. That’s because prediabetes symptoms are virtually nonexistent. Rather, symptoms aren’t likely to occur until your blood-sugar levels fall into the realm of type 2 diabetes. At that point, you may experience one or more of the following symptoms:

• Frequent urination
• Extreme thirst
• Hunger (despite eating)
• Severe fatigue
• Vision problems
• Slow-healing wounds
• Tingling, pain, or numbness in the extremities

Cause for Concern

Type 2 diabetes is a leading risk factor for cardiovascular disease, heart attack, and stroke, as well as chronic kidney disease. Diabetes causes painful diabetic nerve damage (neuropathy), and diabetic retinopathy (a leading cause of blindness), and in men it can contribute to erectile dysfunction. Also, several research investigations have identified a link between diabetes and dementia.

Even if you haven’t advanced to type 2 diabetes, there’s still cause for concern: Some research suggests that the risk of these diabetes complications may already be elevated in people with prediabetes

Understand Your Risk

Although you’re unlikely to recognize prediabetes symptoms, there are plenty of factors to suggest you’re at higher risk of prediabetes. You should be particularly on the lookout for prediabetes if you have a parent or sibling who had type 2 diabetes, you’re physically inactive, or if you’re obese, especially if your waist circumference (measured at the navel) is greater than 40 inches for men and 35 inches for women. You also should watch out for pre-diabetes if you have high blood pressure, low levels of high-density lipoprotein (HDL, “good”) cholesterol, and high levels of triglycerides (a type of fat in the blood).

Talk to your physician about screening for prediabetes. The American Diabetes Association (ADA) recommends screening for adults of any age who are overweight and have risk factors such as a family history of type 2 diabetes, a sedentary lifestyle, high blood pressure, low HDL cholesterol, and high triglycerides. If you have prediabetes, you should be checked for type 2 diabetes every year or two, according to the ADA.

Take Action

If you have prediabetes symptoms, losing 5 to 7 percent of your body weight with a healthful diet and exercise can reduce your risk of progressing to type 2 diabetes over the next three years by 31 percent, suggest results from the landmark Diabetes Prevention Program (DPP) study. In comparison, the study participants who received the diabetes drug metformin reduced their risk of progression by 31 percent.

Based on the DPP results, experts generally recommend that people with prediabetes reduce their risk of type 2 diabetes by lowering their intake of fat and calories, following a heart-healthy diet, and engaging in 30 minutes of moderate-intensity physical activity (such as walking) a day at least five days a week. (See also “Type 2 Diabetes Symptoms and Oral Medications.”) The ADA also recommends that doctors consider adding metformin to these lifestyle habits as an extra safeguard.

For further reading, see these University Health News posts:

• “What Causes Diabetes?“
• “Diabetes Symptoms: Do You Have Risk Factors?“
• “Prediabetes: Diet Advice That Can Keep You Healthy“

Originally published in 2016 and updated.

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In people without diabetes, the pancreas produces the hormone insulin, which acts on the body’s cells, moving “sugar,” or glucose, from the blood into the cells, where it can be used for energy.

• In type 1 diabetes, the body’s immune system attacks and destroys the cells in the pancreas that produce the hormone insulin resulting in an insulin deficiency and therefore elevated blood glucose levels.
• In type 2 diabetes, the cells of the body become resistant to the effects of insulin and the pancreas cannot produce enough extra insulin to compensate for this resistance, resulting in high blood glucose levels.

According to the American Diabetes Association, studies have demonstrated that men are more likely to develop type 2 diabetes symptoms than women, although the reasons for this are unclear.

Men share many of the same risk factors for diabetes as women, including family history, the presence of autoantibodies, living in a colder climate, and possibly exposure to certain viral illnesses for type 1 diabetes and obesity or excess weight, older age, family history, race, sedentary lifestyle, high blood pressure, and abnormal cholesterol levels.

In addition, some researchers believe that diabetes symptoms in men increase with low testosterone levels, which increases the risk for developing insulin resistance or type 2 diabetes. Other scientists think low testosterone is a complication of type 2 diabetes. Either way, there is a definite link between the two with research demonstrating that men with type 2 diabetes are twice as likely to have low testosterone levels as men without diabetes.

Diabetes Symptoms in Men

While men experience many of the classic signs of diabetes that women experience such as increased thirst, increased urination, fatigue, and blurred vision, there are some diabetes symptoms in men that are unique.

• Erectile Dysfunction (ED): Men with diabetes are 2 to 3 times more likely to experience impotence or erectile dysfunction than men without diabetes. There is some evidence that suggests ED may be an early sign of diabetes in men 45 years old and younger. There are two possible causes of ED in men with diabetes. The body’s response to sexual stimuli is involuntary and mediated by nerves that are called autonomic nerves. Diabetes can damage these nerves leading to ED. Additionally, diabetes can also damage the blood vessels that allow an erection to occur resulting in ED. It is important to note that there are other causes of ED including some medications, high blood pressure, and cardiovascular disease. If you have diabetes and develop ED, you should consult with your healthcare provider to determine the cause.
• Retrograde ejaculation: In retrograde ejaculation some or all of a man’s semen enters the bladder instead of being released from the tip of the penis. This is caused by nerve damage that affects the internal muscles, also called sphincters, that normally prevent semen from entering the bladder. Retrograde ejaculation does not affect orgasm, but may cause fertility problems.
• Recurrent genital thrush: Elevated blood sugar levels can lead to increased yeast infections of the penis, resulting in redness, swelling, itchiness, and discharge around the head of the penis.
• Reduced lean muscle mass: Men with diabetes may experience a loss of lean muscle mass. This is particularly true for men with diabetes who also have low testosterone levels.

Metabolic syndrome–characterized by a pear-shaped or apple-shaped body type–is an early warning sign of pre-diabetes and diabetes.

Complications in Men with Diabetes

Men can suffer from many of the same complications of diabetes as women including heart disease, nerve damage or neuropathy, eye damage, kidney damage, and foot problems. Some studies have demonstrated that men with diabetes suffer from the complications of stroke and kidney disease more than women, but other studies have not demonstrated this. Men can also experience additional complications:

• Infertility: Men who suffer from retrograde ejaculation may have problems with fertility.
• Reduced libido: Men who suffer from low testosterone or erectile dysfunction may experience diminished interest in sex.

What Can Men Do to Avoid Diabetes Complications?

All people with diabetes are encouraged to maximize control of their blood glucose levels, adopt a healthy, balanced diet, increase their physical activity, and maintain a healthy weight to increase their odds of avoiding diabetes complications. In addition, men should consult with their urologist to discuss treatment options for symptoms like ED which can include medications, the use of pumps, and even surgery.

Men with retrograde ejaculation wishing to father a child can seek help from a urologist specializing in fertility issues who may be able to collect sperm from urine and utilize it for artificial insemination. Low testosterone levels can easily be treated with hormone injections, patches, or gels.

Knowing what causes diabetes, following your healthcare provider’s recommendations for diabetes management, understanding the signs of complications, and listening to your body so that you can identify symptoms of diabetes are all valuable steps any man with diabetes should take.