In addition to the usual diabetes symptoms of excessive thirst and excessive urination, the initial symptoms of diabetic ketoacidosis also include nausea, vomiting, fatigue, and—particularly in children—abdominal pain.

read more , and the breath smells fruity or like nail polish remover. Without treatment, diabetic ketoacidosis can progress to coma and death, sometimes very quickly.

Stage 1: Presence in the blood of two or more diabetes-specific antibodies substances or markers that indicate that there is inflammation or damage to the insulin -producing cells of the pancreas in people with normal blood sugar levels and no symptoms of diabetes.

After type 1 diabetes has begun, some people can have a temporary phase of near-normal glucose levels honeymoon phase due to partial recovery of insulin secretion. People with type 2 diabetes may not have any symptoms for years or decades before they are diagnosed.

Symptoms may be subtle. Increased urination and thirst are mild at first and gradually worsen over weeks or months. Eventually, people feel extremely fatigued, are likely to develop blurred vision, and may become dehydrated.

Because people with type 2 diabetes produce some insulin , ketoacidosis Diabetic Ketoacidosis Diabetic ketoacidosis is an acute complication of diabetes that occurs mostly in type 1 diabetes mellitus. read more does not usually develop even when type 2 diabetes is untreated for a long time.

Such high levels often happen as the result of some superimposed stress, such as an infection or medication use. When the blood glucose levels get very high, people may develop severe dehydration Dehydration Dehydration is a deficiency of water in the body. Vomiting, diarrhea, excessive sweating, burns, kidney failure, and use of diuretics may cause dehydration.

People feel thirsty, and as dehydration read more , which may lead to mental confusion, drowsiness, and seizures, a condition called hyperosmolar hyperglycemic state Hyperosmolar Hyperglycemic State HHS Hyperosmolar hyperglycemic state is a complication of diabetes mellitus that most often occurs in type 2 diabetes.

Symptoms of hyperosmolar hyperglycemic state include extreme dehydration and Many people with type 2 diabetes are diagnosed by routine blood glucose testing before they develop such severely high blood glucose levels.

Diabetes damages blood vessels, causing them to narrow and therefore restricting blood flow. Because blood vessels throughout the body are affected, people may have many complications of diabetes Complications of Diabetes Mellitus People with diabetes mellitus have many serious long-term complications that affect many areas of the body, particularly the blood vessels, nerves, eyes, and kidneys.

Many organs can be affected, particularly the following:. Brain, causing stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply cerebral infarction. Symptoms occur suddenly Eyes diabetic retinopathy Diabetic Retinopathy Diabetic retinopathy is damage to the retina the transparent, light-sensitive structure at the back of the eye as a result of diabetes.

Blood vessels in the retina can leak blood and fluid read more , causing blindness. Heart, causing heart attack Acute Coronary Syndromes Heart Attack; Myocardial Infarction; Unstable Angina Acute coronary syndromes result from a sudden blockage in a coronary artery.

This blockage causes unstable angina or a heart attack myocardial infarction , depending on the location and amount Kidneys diabetic nephropathy Kidney damage in diabetes People with diabetes mellitus have many serious long-term complications that affect many areas of the body, particularly the blood vessels, nerves, eyes, and kidneys.

read more , causing chronic kidney disease. Nerves diabetic neuropathy Nerve damage in diabetes People with diabetes mellitus have many serious long-term complications that affect many areas of the body, particularly the blood vessels, nerves, eyes, and kidneys. read more , causing decreased sensation, mainly in the feet and legs.

High blood glucose levels also cause disturbances in the body's immune system, so people with diabetes mellitus are particularly susceptible to bacterial and fungal infections. The diagnosis of diabetes is made when people have abnormally high levels of glucose in the blood.

Doctors do screening tests Screening for Diabetes Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar glucose levels to be abnormally high.

Symptoms of diabetes may read more on people who are at risk of diabetes but have no symptoms. People may have type 2 diabetes and no symptoms, so it is important for people with risk factors to have recommended screening tests. Doctors check blood glucose levels in people who have symptoms of diabetes, such as increased thirst, urination, or hunger.

Additionally, doctors may check blood glucose levels in people who have disorders that can be complications of diabetes, such as frequent infections, foot ulcers, and yeast infections. To accurately evaluate blood glucose levels, doctors usually use a blood sample taken after people have fasted overnight.

However, it is possible to use blood samples taken after people have eaten. Some elevation of blood glucose levels after eating is normal, but even after a meal the levels should not be very high. Doctors can also measure the level of a protein, hemoglobin A1C also called glycosylated or glycolated hemoglobin , in the blood, which reflects the person's long-term trends in blood glucose levels rather than rapid changes.

Hemoglobin is the red, oxygen-carrying substance in red blood cells. When blood is exposed to high blood glucose levels over a period of time, glucose attaches to the hemoglobin and forms glycosylated hemoglobin. The hemoglobin A1C level blood test is reported as the percentage of hemoglobin that is A1C.

Measurements of hemoglobin A1C can be used to diagnose diabetes when testing is done by a certified laboratory not by instruments used at home or in a doctor's office. People with a hemoglobin A1C level of 6. If the level is between 5.

Another kind of blood test, an oral glucose tolerance test, may be done in certain situations, such as screening pregnant women for gestational diabetes Gestational diabetes For women who have diabetes before they become pregnant, the risks of complications during pregnancy depend on how long diabetes has been present and whether complications of diabetes, such read more or testing older adults who have symptoms of diabetes but normal glucose levels when fasting.

However, it is not routinely used for testing for diabetes because the test can be very cumbersome. In this test, people fast, have a blood sample taken to determine the fasting blood glucose level, and then drink a special solution containing a large, standard amount of glucose.

More blood samples are then taken over the next 2 to 3 hours and are tested to determine whether the glucose in the blood rises to abnormally high levels. Blood glucose levels are often checked during a routine physical examination. Checking the levels of glucose in the blood regularly is particularly important in older adults because diabetes is so common in later life.

People may have diabetes, particularly type 2 diabetes, and not know it. Screening for type 1 diabetes is not recommended for all children or adults.

Doctors sometimes do tests to screen for type 1 diabetes in people at high risk of type 1 diabetes such as siblings or children of people who have type 1 diabetes.

Testing for insulin antibodies allow doctors to identify people with early stage type 1 diabetes and start preventive measures. Have prediabetes Prediabetes Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar glucose levels to be abnormally high.

Have had diabetes during pregnancy or had a baby who weighed more than 9 pounds 4, grams at birth. Have high blood pressure High Blood Pressure High blood pressure hypertension is persistently high pressure in the arteries.

Often no cause for high blood pressure can be identified, but sometimes it occurs as a result of an underlying Lifestyle, genetics, disorders such as low thyroid hormone levels Have steatotic liver disease Fatty Liver Fatty liver is an abnormal accumulation of certain fats triglycerides inside liver cells.

People with fatty liver may feel tired or have mild abdominal discomfort but otherwise have no symptoms read more previously called fatty liver disease. Have polycystic ovary disease Polycystic Ovary Syndrome PCOS Polycystic ovary syndrome is characterized by irregular or no menstrual periods and often obesity or symptoms caused by high levels of male hormones androgens , such as excess body hair and Have HIV infection Human Immunodeficiency Virus HIV Infection Human immunodeficiency virus HIV infection is a viral infection that progressively destroys certain white blood cells and is treated with antiretroviral medications.

If untreated, it can cause Diabetes risk can also be estimated using a risk calculators from the American Diabetes Association. Doctors may measure fasting blood glucose levels and hemoglobin A1C level, or do an oral glucose tolerance test.

If the test results are on the border between normal and abnormal, doctors do the screening tests more often, at least once a year. In type 1 diabetes, insulin injections. In type 2 diabetes, often medications by mouth and sometimes insulin or other medications by injection.

Diet, exercise, and education are the cornerstones of treatment of diabetes. Weight loss is important for people who have overweight. Some people with type 2 diabetes and mildly elevated glucose levels can start with diet, exercise, and weight loss only.

However, in people with more severe glucose abnormalities, or in whom lifestyle modification is not sufficient to normalize glucose, diabetes medications are required. People with type 1 diabetes no matter their blood glucose levels require medication when first diagnosed.

Because complications are less likely to develop if people with diabetes strictly control their blood glucose levels, the goal of diabetes treatment is to keep blood glucose levels as close to the normal range as possible.

It is helpful for people with diabetes to carry or wear medical identification such as a bracelet or tag to alert health care professionals to the presence of diabetes. This information allows health care professionals to start life-saving treatment quickly, especially in the case of injury or change in mental status.

Diabetic ketoacidosis Diabetic Ketoacidosis Diabetic ketoacidosis is an acute complication of diabetes that occurs mostly in type 1 diabetes mellitus. read more and hyperosmolar hyperglycemic state Hyperosmolar Hyperglycemic State HHS Hyperosmolar hyperglycemic state is a complication of diabetes mellitus that most often occurs in type 2 diabetes.

read more are medical emergencies because they can cause coma and death. Treatment is similar for both and centers around giving intravenous fluids and insulin. People with diabetes benefit greatly from learning about the disorder, understanding how diet and exercise affect their blood glucose levels, and knowing how to avoid complications.

A nurse trained in diabetes education can provide information about managing diet, exercising, monitoring blood glucose levels Monitoring blood glucose levels Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar glucose levels to be abnormally high.

read more , and taking medication Medication Treatment of Diabetes Mellitus Many people with diabetes require medication to lower blood glucose levels, relieve symptoms, and prevent complications of diabetes.

There are two types of diabetes mellitus Type 1, in which People with diabetes should stop smoking Smoking Cessation Most people who smoke want to quit and have tried doing so with limited success. Effective tools to help quit smoking include counseling, nicotine replacement products, and medications.

read more and consume only moderate amounts of alcohol up to one drink per day for women and two for men. Diet management is very important for people with either type of diabetes mellitus.

Doctors recommend a healthy, balanced diet and efforts to maintain a healthy weight. People with diabetes can benefit from meeting with a dietitian or a diabetes educator to develop an optimal eating plan.

Such a plan includes. People who are taking insulin should avoid long periods between meals to prevent hypoglycemia Hypoglycemia Hypoglycemia is abnormally low levels of sugar glucose in the blood.

Hypoglycemia is most often caused by medications taken to control diabetes. Much less common causes of hypoglycemia include Although protein and fat in the diet contribute to the number of calories a person eats, only the number of carbohydrates has a direct effect on blood glucose levels.

The American Diabetes Association has many helpful tips on diet , including recipes. read more is needed to decrease the risk of heart disease. People with type 1 diabetes and certain people with type 2 diabetes may use carbohydrate counting or the carbohydrate exchange system to match their insulin dose to the carbohydrate content of their meal.

However, the carbohydrate-to- insulin ratio the amount of insulin taken for each gram of carbohydrate in the meal varies for each person, and people with diabetes need to work closely with a dietician who has experience in working with people with diabetes to master the technique.

Some experts have advised use of the glycemic index a measure of the impact of an ingested carbohydrate-containing food on the blood glucose level to delineate between rapid and slowly metabolized carbohydrates, although there is little evidence to support this approach.

Exercise, in appropriate amounts at least minutes a week spread out over at least 3 days , can also help people control their weight and improve blood glucose levels. Because blood glucose levels go down during exercise, people must be alert for symptoms of hypoglycemia Symptoms Hypoglycemia is abnormally low levels of sugar glucose in the blood.

Some people need to eat a small snack during prolonged exercise, decrease their insulin dose, or both. Many people, especially those with type 2 diabetes, have overweight or obesity.

Some people with type 2 diabetes may be able to avoid or delay the need to take medications by achieving and maintaining a healthy weight. Weight loss is also important in these people because excess weight contributes to complications of diabetes.

When people with obesity and diabetes have trouble losing weight with diet and exercise alone, doctors may give a weight-loss medication or recommend bariatric surgery Metabolic and Bariatric Surgery Metabolic and bariatric weight-loss surgery alters the stomach, intestine, or both to produce weight loss in people have obesity or overweight and have metabolic disorders related to obesity read more surgery to cause weight loss.

Certain diabetes medications can induce weight loss Medications Obesity is a chronic, recurring complex disorder characterized by excess body weight.

read more , especially glucagon -like peptide 1 GLP-1 and sodium-glucose co-transporter-2 SGLT2 inhibitor medications. General treatment of type 2 diabetes Treatment Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar glucose levels to be abnormally high.

read more often requires lifestyle changes, including weight loss, diet, and exercise. Regular monitoring of blood glucose levels is often needed to prevent complications of diabetes Complications of Diabetes Mellitus People with diabetes mellitus have many serious long-term complications that affect many areas of the body, particularly the blood vessels, nerves, eyes, and kidneys.

Because diabetes eventually affects blood vessels throughout the body, people with diabetes are likely to develop complications Complications of Diabetes Mellitus People with diabetes mellitus have many serious long-term complications that affect many areas of the body, particularly the blood vessels, nerves, eyes, and kidneys.

read more related to problems with blood vessels. Glucose that remains high for long periods causes build-up in the walls of blood vessels, causing them to thicken and leak and risking development of atherosclerosis, stroke, eye problems, and other problems.

Because the risk of complications is so high in people with diabetes, it is important that people carefully control blood glucose levels. Doctors also recommend that people undergo regular monitoring Monitoring and Preventing Diabetes Complications People with diabetes mellitus have many serious long-term complications that affect many areas of the body, particularly the blood vessels, nerves, eyes, and kidneys.

read more to prevent complications. There are many medications used to treat diabetes Medication Treatment of Diabetes Mellitus Many people with diabetes require medication to lower blood glucose levels, relieve symptoms, and prevent complications of diabetes.

People with type 1 diabetes require insulin injections to lower blood glucose levels. Most people with type 2 diabetes require medications by mouth to lower blood glucose levels but some also require insulin or other injectable medications. People with type 1 diabetes sometimes receive transplantation of an entire pancreas or of only the insulin -producing cells from a donor pancreas.

This procedure may allow people with type 1 diabetes mellitus to maintain normal glucose levels. However, because immunosuppressant medications must be given to prevent the body from rejecting the transplanted cells, pancreas transplantation Pancreas Transplantation Pancreas transplantation is the removal of a healthy pancreas from a recently deceased person or rarely a part of a pancreas from a living person and its transfer into person with severe diabetes read more is usually done only in people who have serious complications due to diabetes or who are receiving another transplanted organ such as a kidney and will require immunosuppressants anyway.

Older adults and people with many medical problems, particularly serious problems, need to follow the same general principles of diabetes management—education, diet, exercise, and medications—as younger or healthier people.

However, risking hypoglycemia Hypoglycemia Hypoglycemia is abnormally low levels of sugar glucose in the blood. read more a low blood glucose level by trying to strictly control blood glucose levels may be harmful for frail people or people with many medical problems.

Poor eyesight may make it hard for people to read glucose meters and dose scales on insulin syringes. People with arthritis or Parkinson disease or who have had a stroke may have problems manipulating the syringe.

In addition to learning about diabetes itself, people with many medical problems may have to learn how to fit management of diabetes in with their management of other conditions. Learning about how to avoid complications, such as dehydration, skin breakdown, and circulation problems, and to manage factors that can contribute to complications of diabetes, such as high blood pressure and high cholesterol levels, is especially important.

Such problems become more common as people age, whether they have diabetes or not. Many older adults have difficulty following a healthy, balanced diet that can control blood glucose levels and weight.

Changing long-held food preferences and dietary habits may be hard. Some people have other disorders that can be affected by diet and may not understand how to integrate the dietary recommendations for their various disorders.

Some people cannot control what they eat because someone else is cooking for them—at home or in a nursing home or other institution. When people with diabetes do not do their own cooking, the people who shop and prepare meals for them must also understand the diet that is needed.

These people and their caregivers usually benefit from meeting with a dietitian to develop a healthy, feasible eating plan. Some people may have a difficult time adding exercise to their daily life, particularly if they have not been active in the past or if they have a disorder that limits their movement, such as arthritis.

However, they may be able to add exercise to their usual routine. For example, people can walk instead of drive or climb the stairs instead of taking the elevator.

Taking the medications used to treat diabetes, particularly insulin , may be difficult for some people. For those with vision problems or other problems that make accurately filling a syringe difficult, a caregiver can prepare the syringes ahead of time and store them in the refrigerator.

People whose insulin dose is stable may purchase prefilled syringes. Prefilled insulin pen devices may be easier for people with physical limitations. Some of these devices have large numbers and easy-to-turn dials.

Poor vision, limited manual dexterity due to arthritis, tremor, or stroke, or other physical limitations may make monitoring blood glucose levels more difficult for some people.

However, special monitors are available. Some have large numerical displays that are easier to read. Some provide audible instructions and results. Some monitors read blood glucose levels through the skin and do not require a blood sample.

People can consult a diabetes educator to determine which meter is most appropriate. The most common complication of treating high blood glucose levels is low blood glucose levels hypoglycemia Hypoglycemia Hypoglycemia is abnormally low levels of sugar glucose in the blood.

The risk is greatest for people who are frail, who are sick enough to require frequent hospital admissions, or who are taking several medications.

Of all available medications to treat diabetes, long-acting sulfonylurea medications or insulin are most likely to cause low blood glucose levels in people with severe or many medical problems and especially in older adults.

When they take these medications, these people are also more likely to have serious symptoms, such as fainting and falling, and to have difficulty thinking or using parts of the body due to low blood glucose levels. In older adults, hypoglycemia may be less obvious than in younger people. Confusion caused by hypoglycemia may be mistaken for dementia Dementia Dementia is a slow, progressive decline in mental function including memory, thinking, judgment, and the ability to learn.

Typically, symptoms include memory loss, problems using language and read more or the sedative effect of medications. Also, people who have difficulty communicating as after a stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply cerebral infarction.

read more or as a result of dementia may not be able to let anyone know they are having symptoms. People with type 1 diabetes may have more frequent swings in blood glucose levels because insulin production is completely absent. Infection, delayed movement of food through the stomach, and other hormonal disorders may also contribute to blood glucose swings.

In all people who have difficulty controlling blood glucose, doctors look for other disorders that might be causing the problem and also give people additional education on how to monitor diabetes and take their medications. Monitoring blood glucose levels is an essential part of diabetes care.

Routine blood glucose monitoring provides the information needed to make necessary adjustments in medications, diet, and exercise regimens. TZDs Thiazolidinediones. Diabetes Canada has several resources for practitioners and can be found at: guidelines. They also have the Diabetes Canada CPG Webinar Series available at: guidelines.

RACE: Rapid Access to Consultative Expertise Program — www. RACE means timely telephone advice from specialist for Physicians, Medical Residents, Nurse Practitioners, Midwives, all in one phone call. Monday to Friday — Online at www. ca or though Apple or Android mobile device.

For more information on how to download RACE mobile applications, please visit www. Pathways — PathwaysBC. ca An online resource that allows GPs and nurse practitioners and their office staff to quickly access current and accurate referral information, including wait times and areas of expertise, for specialists and specialty clinics.

In addition, Pathways makes available hundreds of patient and physician resources that are categorized and searchable. General Practice Services Committee — www. Health Data Coalition: hdcbc. An online, physician-led data sharing platform that can assist you in assessing your own practice in areas such as chronic disease management or medication prescribing.

HDC data can graphically represent patients in your practice with chronic kidney disease in a clear and simple fashion, allowing for reflection on practice and tracking improvements over time. HealthLinkBC: healthlinkbc. HealthLinkBC provides reliable non-emergency health information and advice to patients in BC.

Information and advice on managing Diabetes in several languages is available by telephone, website, a mobile app and a collection of print resources. People can speak to a health services navigator, registered dietitian, registered nurse, qualified exercise professional, or a pharmacist by calling toll-free in B.

C, or for the deaf and hard of hearing. See also Associated Documents: Diabetes Patient Care Flow Sheet. Diabetes Patient Care Flow Sheet. List of Contributors. This guideline was developed by the Guidelines and Protocols Advisory Committee in collaboration with the Provincial Laboratory Medicine Services, and adopted under the Medical Services Act and the Laboratory Services Act.

For more information about how BC Guidelines are developed, refer to the GPAC Handbook available at BCGuidelines. ca: GPAC Handbook. Email: hlth. guidelines gov. The Clinical Practice Guidelines the guidelines have been developed by the guidelines and Protocols Advisory Committee on behalf of the Medical Services Commission.

The guidelines are intended to give an understanding of a clinical problem, and outline one or more preferred approaches to the investigation and management of the problem.

The guidelines are not intended as a substitute for the advice or professional judgment of a health care professional, nor are they intended to be the only approach to the management of clinical problem. We cannot respond to patients or patient advocates requesting advice on issues related to medical conditions.

If you need medical advice, please contact a health care professional. BC Guidelines is always looking for knowledgeable practitioners to chair and serve on our working groups. Email BC Guidelines at hlth. ca and ask for an application package today. Note: We cannot respond to patients or patient advocates requesting advice on issues related to medical conditions.

The B. Public Service acknowledges the territories of First Nations around B. and is grateful to carry out our work on these lands. We acknowledge the rights, interests, priorities, and concerns of all Indigenous Peoples - First Nations, Métis, and Inuit - respecting and acknowledging their distinct cultures, histories, rights, laws, and governments.

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Diabetes Care. Key Recommendations Diabetes care should be holistic and centred around the person living with diabetes. Include an individualized management plan developed by the person with diabetes and their primary care provider s. Goals include reducing microvascular and cardiovascular complication, reducing hyperglycemia and its symptoms, reducing risk and occurrence of hypoglycemia, and improving quality of life.

The 5 Rs describe the key components to consider when organizing diabetes care in the office or clinic: Recognize, Register, Resource, Relay, and Recall.

Glycosylated hemoglobin A1C ,fasting plasma glucose FPG or rarely 2-hour plasma glucose 2hPG as part of a 75g oral glucose tolerance test OGTT can be used for diagnosis and screening.

Individualized glycemic targets are based on age, duration of diabetes, risk of hypoglycemia, cardiovascular disease presence, and life expectancy. Measure A1C every 3 months to assess if glycemic goals are met.

Consider testing every 6 months if targets are consistently met, and treatment and lifestyle are stable. Management of Type 2 diabetes: A systematic approach to cardiovascular management is recommended, including healthy behaviour choices, glycemic and blood pressure control, and pharmacological interventions.

Metformin is recommended as initial pharmacotherapy. These agents should be used even if A1C is at target. Achieve glycemic goal A1C target in months.

Adjust therapy if glycemic targets are not reached or if there is a change in clinical status. If frailty, cognitive decline, or limited life expectancy are present, target an A1C of 7.

Prioritize use of agents with low risk of hypoglycemia. Guideline Related Resources Download the following: Full Guideline PDF, KB Associated Document: Diabetes Patient Care flow Sheet PDF, KB List of Contributors PDF, KB.

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