Insulin Pump For Diabetes Mellitus

What is an insulin pump?

The most recently available advance in insulin delivery is the insulin pump. In the United States, MiniMed and Disetronic market the insulin pump. An insulin pump is composed of a pump reservoir similar to that of an insulin cartridge, a battery-operated pump, and a computer chip that allows the user to control the exact amount of insulin being delivered.


How big is an insulin pump?

Currently, pumps on the market are about the size of a standard communications beeper.


How does an insulin pump work?

The pump is attached to a thin plastic tube (an infusion set) that has a soft cannula (or plastic needle) at the end through which insulin passes. This cannula is inserted under the skin, usually on the abdomen. The cannula is changed every two days. The tubing can be disconnected from the pump while showering or swimming. The pump is used for continuous insulin delivery, 24 hours a day. The amount of insulin is programmed and is administered at a constant rate (basal rate). Often, the amount of insulin needed over the course of 24 hours varies depending on factors like exercise, activity level, and sleep.

The insulin pump allows the user to program many different basal rates to allow for variation in lifestyle. In addition, the user can program the pump to deliver a bolus (large dose of insulin) during meals to cover the excess demands of carbohydrate ingestion.


How common is an insulin pump?

Over 50,000 people worldwide are using an insulin pump. This number is growing dramatically as these devices become smaller and more user-friendly. Insulin pumps allow for tight blood sugar control and lifestyle flexibility while minimizing the effects of low blood sugar (hypoglycemia). At present, the pump is the closest device on the market to an artificial pancreas. More recently, newer models of the pump have been developed that do not require a tubing, in fact - the insulin delivery device is placed directly on the skin and any adjustments needed for insulin delivery are made through a PDA like device that must be kept within a 6 foot range of the insulin delivery device, and can be worn in a pocket, kept in a purse, or on a tabletop when working.

Probably the most exciting innovation in pump technology is the ability to use the pump in tandem with newer glucose sensing technology. Glucose sensors have improved dramatically in the last few years, and are an option for patients to gain further insight into their patterns of glucose response to tailor a more individual treatment regimen. The newest generation of sensors allows for a real time glucose value to be given to the patient. The implantable sensor communicates wirelessly with a pager-sized device that has a screen. The device is kept in proximity to the sensor to allow for transfer of data, however, it can be a few feet away and still receive transmitted information. Depending on the model, the screen displays the blood glucose reading, a thread of readings over time, and a potential rate of change in the glucose values. The sensors can be programmed to produce a "beep" if blood sugars are in a range that is selected as too high or too low. Some can provide a warning beep if the drop in blood sugar is occurring too quickly.

To take things one step further, there is one particular sensor that is new to the market that is designed to communicate directly with the insulin pump. While the pump does not yet respond directly to information from the sensor, it does "request" a response from the patient if there is a need for adjustments according to the patterns it is programmed to detect. The ultimate goal of this technology is to "close the loop" by continuously sensing what the body needs, and then responding by providing the appropriate dose of insulin. While this technology is a few more years in the making, the strides in this direction continue to grow.

Gestational Diabetes Treatment

Overview

Treatment of gestational diabetes involves eating a balanced diet and getting regular exercise to keep your blood sugar (glucose) levels within an acceptable range.

The goal is to reduce the risk of complications for you and your baby during pregnancy and after birth. If your blood sugar level and the fetus's weight remain normal, the risk of complications is no greater than if you did not have gestational diabetes.

During pregnancy

Treatment for gestational diabetes during pregnancy includes:

Eating a balanced diet. Controlling the amount of carbohydrates in your diet allows your body's naturally produced insulin to keep blood glucose levels within the acceptable range. Nutritional counseling by a registered dietitian is an important part of treatment for gestational diabetes.

Getting regular exercise. Following a balanced diet and getting regular exercise may prevent the need for insulin injections.

Monitoring blood glucose levels. Take a home blood sugar test 1 hour after the first bite of each meal. Some experts recommend that women who take insulin should also test their blood sugar before meals. Keeping blood sugar levels within the acceptable range reduces the risk that the fetus will gain excessive weight, leading to possible complications.

Monitoring fetal growth and well-being. You may be asked to monitor fetal movements and report any significant decrease. Fetal ultrasound is used to evaluate fetal growth during pregnancy. If the fetus is growing larger than expected, you may need to take insulin injections. If you take insulin, a nonstress test may be done to evaluate the fetus's heart rate. A nonstress test may also be done near the expected delivery date for all women with gestational diabetes.

Having regular medical checkups. Women with gestational diabetes are twice as likely to develop high blood pressure as other pregnant women. Therefore, you need regular medical visits to monitor your blood pressure and to check your urine for protein. Your health professional may ask you to keep daily food records. They may be reviewed along with your weight to make sure you are getting adequate nutrition.

Taking insulin injections. If blood sugar levels are not remaining within an acceptable range after at least 2 weeks of eating a balanced diet and exercising regularly, insulin injections will be needed. Insulin may be started after 1 week of diet and exercise if your blood sugar level is not within an acceptable range. Usually, when the baby is delivered, a woman's blood sugar level returns to normal and she no longer needs to take insulin.

Most obstetricians generally advise pregnant women not to diet, and a total weight gain during pregnancy of about 25 lb (11.3 kg) to 35 lb (15.9 kg) is expected. However, if you were very overweight before becoming pregnant, a weight gain of less than 15 lb (6.8 kg) is acceptable. If you are obese, your doctor will probably ask you to restrict your caloric intake, even during your pregnancy.

During labor and delivery

Once your pregnancy has reached its 38th week, your doctor may want to deliver your baby to reduce the chance that the baby will be abnormally large (macrosomia). At this point, your obstetrician may try to induce labor or perform a cesarean section (C-section) to deliver the baby. Unless your fetus is not as developed as it should be, this delivery should not harm it. If allowed to become too large, it may be too difficult to deliver your fetus safely. Periodic ultrasound measurements help determine the size of the fetus and the need for early delivery. However, since treatment of gestational diabetes is very successful in preventing large babies, many obstetricians will increase fetal monitoring rather than deliver early.

During labor and delivery, you and the baby are monitored closely. Monitoring includes:

--Your blood glucose levels, which will be tested at least every 1?2 hours. If your level rises too high, you may be given small amounts of insulin through a vein (intravenous, or IV). If your level drops too low, you may be given IV fluid that contains glucose.

--The fetal heart rate, which provides an indication of how well the baby is tolerating the birth. Internal or external fetal heart monitoring may be used. If the baby is large or does not seem to be tolerating labor, surgery (cesarean section, or C-section) may be needed to deliver the baby. However, most women with gestational diabetes are able to deliver their babies naturally.

After delivery

After delivery, you and the baby need to be monitored closely.

--Your blood glucose levels may be tested as often as hourly for the first few hours. In most cases, women do not need to have insulin injections after delivery.

--The baby's blood glucose levels will be monitored. If your blood glucose levels were above the acceptable range during pregnancy, the baby's body will continue to produce extra insulin for several hours after birth. The extra insulin may cause the baby's blood glucose to drop too low (hypoglycemia). For babies who are able to take feedings by mouth, breast-feeding seems to help protect against low blood sugar.12 If the baby's blood glucose level drops below the acceptable range, he or she may need extra sugar, such as a sugar water drink or glucose given intravenously.

--The baby's blood may be checked for low calcium, high bilirubin, and extra red blood cells.

What to Think About

The blood glucose levels of most women with gestational diabetes return to normal within a few hours after delivery. However, women who have had gestational diabetes in a previous pregnancy are at risk for developing type 2 diabetes later in life. In addition, between 30% and 69% of women who have gestational diabetes develop the condition again in future pregnancies.

Gestational Diabetes Diet Plan

What is it? Gestational (jes-ta-shun-ull) diabetes is when your blood sugar (glucose) is too high while you are pregnant. Gestational diabetes often goes away after the baby is born. But, you may get diabetes later if you have diabetes during pregnancy.

In diabetes, your body does not make enough insulin or the insulin it makes does not work right. This causes your blood sugar levels to be too high. This can be harmful to you and your unborn child. Controlling your blood sugar is important for the health of your unborn baby.

The carbohydrates (kar-bo-hi-drates) in your food become glucose in your body. Glucose is a major energy source for your body. Carbohydrates come from starchy foods such as breads, pasta, potatoes, rice, and other grains. Carbohydrates are also found in fruits, dairy foods, vegetables, sugar, and sweets.

You need to eat the right amount of carbohydrates, protein, and fat while you are pregnant. This requires more planning if you are taking insulin to control your blood sugar while you are pregnant.

What is carbohydrate counting? Carbohydrate counting means keeping track of the amount of carbohydrates you eat every day. You should eat the same amount of carbohydrates at the same times each day. This will help keep your blood sugar within the normal range.

One serving of a carbohydrate food contains 12 to 15 grams of carbohydrate. A serving is equal to one of the portions listed below. You can exchange or trade one carbohydrate food for another from the same food group. For example, you can choose 1 slice of bread instead of 1/2 cup cooked cereal.

Vegetables contain only 5 grams of carbohydrate per serving. Do not count vegetables as carbohydrates unless you eat more than 2 servings per meal. Meat, meat substitutes, and fats are not counted as carbohydrates.

Care:

Calorie Intake:

Most pregnant women need about 300 extra calories per day in the second and third trimesters to gain enough weight. This equals about 16 to 17 calories per pound of ideal body weight.

An extra 10 to 12 grams of protein per day is also needed to help your baby grow normally. It is also helpful to get 45 to 60% of your calories from carbohydrates, 15 to 25% from protein, and 20 to 30% from fat.

Eating Plans:

Your dietitian (di-uh-tih-shun) will show you how to meet the guidelines above. You may use the sample menu below or the Diabetes Meal Planning Guide to do this. Ask for the CareNotes?handout about the diabetic exchange diet to find the serving sizes of foods not on the lists below.

Some people with gestational diabetes can control their blood sugar with diet alone. They do this by eating 3 meals and 1 to 3 snacks each day.

You will need a snack at bedtime to prevent your blood sugar levels from being too low overnight. Your dietitian will tell you if you need snacks in the morning or afternoon.

Eat at the same times each day, whenever possible, and never skip meals or snacks. Spread your food out evenly over the day so that you eat about every 2 to 3 hours. Eat only the amount that is on the food list. Or the amount your dietitian tells you to eat for each type of carbohydrate food.

Avoid foods and beverages with added sugar, corn syrup, honey, molasses, or maple syrup, or jams and jellies.

Read the labels of packaged foods to find the grams of carbohydrate a serving has in it.

Other Factors:

Choosing high fiber foods will help control your blood sugar and have regular bowel movements. High fiber foods are fresh fruits and vegetables, whole grain breads, cooked dried beans, and bran cereals.

Check with your doctor before exercising during pregnancy. Tell your dietitian about your exercise plan so your diet can be changed if needed. You may need extra carbohydrates before exercise to keep your blood sugar from dropping too low.

Talk with your caregiver if your blood sugar levels are too low or too high. Make sure your cholesterol and other blood lipids (fats) are checked at least once a year. You may need to follow a lowfat diet if they are too high.

Serving Sizes: Use the list below to measure foods and serving sizes. A serving size means the size of food after it is cooked or prepared.

1 pint or 2 cups (16 fluid ounces) of liquid is the size of 1-1/3 soda-pop cans.

1-1/2 cup (12 fluid ounces) of liquid is the size of a soda-pop can.

1 cup of food is the size of a large handful, or 8 fluid ounces of liquid.

?cup of food is about half of a large handful, or 4 fluid ounces of liquid.

2 tablespoons (Tbsp) is about the size of a large walnut.

1 tablespoon (Tbsp) is about the size of the tip of your thumb (from the last crease).

1 teaspoon (tsp) is about the size of the tip of your little finger (from the last crease).

3 ounces of cooked meat, fish, or poultry is about the size of a deck of cards.

1 ounce of cooked meat, fish, or poultry is about ?cup.

One ounce of hard cheese is about a 1 inch cube.

A serving of vegetables is ?cup (1/2 handful) cooked, or 1 cup (1 handful) raw.

CARBOHYDRATE FOODS AND SERVING SIZES

Breads and Starches: Each serving contains 15 grams carbohydrate. Eat ____ servings per day from this list. Most people need 6-10 servings per day.

1 slice bread (1 ounce)

1/2cup cooked pasta, corn, cooked cereal, mashed potato, or green peas

1/3 cup cooked rice, dried beans, or dried peas

3/4 cup flake cereal

1/2 hamburger or hot dog bun, English muffin, or frozen bagel

3 cups air-popped popcorn

1 small (3 inch) potato

2 rice cakes

6 saltines or three (2-1/2 inch squares) graham crackers

Fruits: Each serving contains 15 grams carbohydrate. Eat ____ servings per day from this list. Most people need 2-4 servings per day. Avoid juice or limit to 1/2 cup per day if your blood sugar levels are too high.

1/2 cup apple, orange, or grapefruit juice

1 small (2-1/2 inch) apple, peach, or orange

1/2 cup applesauce or canned fruit

3/4 cup fresh blueberries

15 small grapes or 12 large grapes

1 kiwi fruit

1/2 large pear or fresh grapefruit

2 Tbsp raisins or 1/4 cup dried fruit

1-1/4 cup fresh strawberries or melon cubes

Dairy: Each serving contains 12 grams carbohydrate. Eat or drink____ servings per day from this list. Most people need 2-3 servings per day.

1/2 cup sugar free custard, pudding, or evaporated milk

1 cup fresh milk or sugar-free yogurt

1/3 cup nonfat milk powder

Vegetables: Each serving contains 5 grams carbohydrate. Only count a vegetable as carbohydrate if you have more than 2 servings per meal. Eat ____ servings per day from this list. Most people need 2-4 servings per day.

2 Tbsp tomato sauce

1 cup vegetable or tomato juice

1/2 cup cooked vegetables or 1 cup raw vegetables

Combination Foods: Each serving contains about 15 grams carbohydrate. Eat ____ servings per day from this list. Most people need 1-2 servings per day.

1/2 cup of any casserole, like tuna or chicken noodle, macaroni and cheese, chili with meat, or spaghetti and meat sauce

1 cup cream, bean, tomato, or vegetable soup

1/8 of a 10-inch pizza

1/2 of a store-bought pot pie, like chicken, turkey, or beef

One 3 ounce taco

NON-CARBOHYDRATE FOODS TO INCLUDE IN YOUR DIET

Meat / Meat Substitutes: The foods on this list do not count as carbohydrates. Eat ____ servings per day from this list. Most people need 3-5 servings per day.

1/2 cup cottage cheese

1/2 cup cooked dried beans

1 to 2 oz low fat cheese

1 large egg (Limit eggs to 2 or 3 per week.)

2 to 3 oz cooked meat, fish, poultry

2 Tbsp peanut butter

Fats: The foods on this list do not count as carbohydrates. Eat ____ servings per day from this list. Most people need 1-3 servings per day.

6 almonds or 10 small peanuts

1/8 avocado

1 teaspoon oil or margarine

6 small olives

2 Tbsp low calorie salad dressing

1Tbsp regular salad dressing

2200 CALORIE SAMPLE MENU A sample of a 2200 calorie gestational diabetic diet is listed below. A dietitian can help you decide how many snacks you need each day.

Breakfast: 42 grams carbohydrate

3 carbohydrate choices such as.

2 breads or starches, like 1 cup bran cereal or 1 cup cooked oatmeal

1 milk, like 1 cup skim milk, 1% milk, or nonfat sugar-free yogurt

1 ounce meat or protein, like ?cup scrambled egg substitute or lowfat cottage cheese

2 fats, like 2 tsp margarine

Morning Snack: 15 grams carbohydrate

1 fruit, such as 1/2 large banana

1 oz. meat substitute, such as 2 Tbsp peanut butter

Lunch: 67 grams carbohydrate

The following foods can be combined to make a sandwich:

2 carbohydrate choices like 2 slices whole wheat bread

2 ounces meat or protein, like 2 ounces lean roast beef or ?cup water-packed tuna

1 vegetable, like 2 lettuce leaves with 2 slices of tomato

1 fat, like 1 tsp mayonnaise or 1 Tbsp salad dressing

1 fruit, like 1-1/4 cups fresh strawberries

1 vegetable, like 1/2 cup vegetable soup or 1 cup carrot sticks

1 free food, like 12 ounces sugar-free soft drink

1 milk, like 1 cup sugar-free nonfat yogurt

Afternoon snack: 15 grams carbohydrate

1 starch, like 3 squares (2-1/2 inch) graham crackers

Dinner: 82 grams carbohydrate

5 carbohydrate choices such as:

2 starches, like 1 large baked potato or 1 cup cooked pasta

1 starch, like 1 small dinner roll (1 ounce)

1 fruit, like 1 cup melon cubes or 4 fresh apricots

1 milk, like 1 cup skim milk or nonfat sugar-free yogurt

2 vegetables, like 1 cup steamed asparagus and 2 cups tossed salad

3 ounces meat or protein, like grilled chicken breast or salmon

2 fats, like 1 tsp margarine and 2 Tbsp lowfat salad dressing

Evening Snack: 27 grams carbohydrate

1 carbohydrate choice such as 1 bread, 6 whole wheat crackers, or 1 slice whole wheat bread

1 meat or protein, like 1 ounce lowfat cheese or 1 ounce lowfat ham

1 milk, like 1 cup skim milk or nonfat sugar-free yogurt

Totals For The Day: About 2180 calories.

About 248 grams carbohydrate, or 47% of calories.

About 123 grams protein, or 23% of calories.

About 72 grams fat, or 30% of calories.

CALL YOUR CAREGIVER IF:

You have questions about the serving sizes in this diabetic diet.

You have questions about how to prepare or cook foods on this diet.

You have questions about how or where to buy foods on this diet.

You have questions or concerns about your illness, medicine, or this diet.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Gestational Diabetes Test - Detection and Diagnosis

Detection and Diagnosis

Risk assessment for gestational diabetes mellitus should be undertaken at the first prenatal visit. Women with clinical characteristics consistent with a high risk of gestational diabetes mellitus (marked obesity, personal history of gestational diabetes mellitus, glycosuria, or a strong family history of diabetes) should undergo glucose testing (see below) as soon as feasible. If they are found not to have gestational diabetes mellitus at that initial screening, they should be retested between 24 and 28 weeks of gestation. Women of average risk should have testing undertaken at 24 to 28 weeks of gestation. Low-risk status requires no glucose testing, but this category is limited to those women meeting all of the following characteristics:

Age <25 years
Weight normal before pregnancy
Member of an ethnic group with a low prevalence of gestational diabetes mellitus
No known diabetes in first-degree relatives
No history of abnormal glucose tolerance
No history of poor obstetric outcome
A fasting plasma glucose level >126 mg/dL (7.0 mmol/L) or a casual plasma glucose >200 mg/dL (11.1 mmol/L) meets the threshold for the diagnosis of diabetes, if confirmed on a subsequent day, and precludes the need for any glucose challenge. In the absence of this degree of hyperglycemia, evaluation for gestational diabetes mellitus in women with average or high-risk characteristics should follow one of two approaches:

One-step approach: Perform a diagnostic oral glucose tolerance test (OGTT) without prior plasma or serum glucose screening. The one-step approach may be cost-effective in high-risk patients or populations (e.g., some Native-American groups).

Two-step approach: Perform an initial screening by measuring the plasma or serum glucose concentration 1 hour after a 50-g oral glucose load (glucose challenge test [GCT]) and perform a diagnostic oral glucose tolerance test on that subset of women exceeding the glucose threshold value on the glucose challenge test. When the two-step approach is employed, a glucose threshold value >140 mg/dL (7.8 mmol/L) identifies approximately 80% of women with gestational diabetes mellitus, and the yield is further increased to 90% by using a cutoff of >130 mg/dL (7.2 mmol/L).

With either approach, the diagnosis of gestational diabetes mellitus is based on an oral glucose tolerance test. Diagnostic criteria for the 100-g oral glucose tolerance test are shown in Table 1, below. Alternatively, the diagnosis can be made using a 75-g glucose load and the glucose threshold values listed for fasting, 1 hour, and 2 hours (Table 2, below); however, this test is not as well validated for detection of at-risk infants or mothers as the 100-g oral glucose tolerance test.

Gestational Diabetes Symptoms

Symptoms

Increased thirst
Increased urination
Weight loss in spite of increased appetite
Fatigue
Nausea and vomiting
Frequent infections including those of the bladder, vagina, and skin
Blurred vision
Note: Usually there are no symptoms.

Signs and tests

An oral glucose tolerance test between the 24th and 28th weeks of pregnancy is the main test for gestational diabetes.

Diabetes Prevention

If you look at the statistics for sugar consumption in the USA and the percentage of the population with Type II (Adult Onset) diabetes, you'll see they track pretty much one-for-one. A friend of mine has "the other kind" of diabetes--the kind you get through no fault of your own. He is amazed that non-diabetic people live a lifestyle that puts them at such high risk for a disease that complicates his life so much.

Type II (Adult Onset) diabetes is a sugar disease. You can control it, even prevent it. The keys are these:

Managing your insulin (controlling sugar sources)
Eating small portions instead of "filling up" at meals
Keeping your bodyfat percentage down (obesity is a high risk factor)

Let's take a closer look:

Diet

There is no one magic diet that works for everyone. Nor is there a single diet that works best for one individual over a long time. Pay attention to your genetics, and to your ethnic group's traditional foods. If you are African American, that does not mean overcooked vegetables or pork rinds. Such garbage came on the nutritional scene only recently, and is not a true ethnic food. The same is true for Italians who overdose on pepperoni pizza. Being Italian myself as, well as having enjoyed fantastic African cuisine, I can tell you there is a lot more to these diets than the recent introductions often associated with these cultural groups.

Except for Eskimos and a few other highly specialized ethnic groups, all diets must adhere to the same few macronutrient rules. For example:
Eliminate as many processed carbohydrates as possible.
Don't eat carbohydrates 2 hours before bedtime.
Balance your fat/carbos/protein in a roughly 30/40/30 ratio (this is a guideline, not a hard and fast rule--it doesn't work for everyone).
Eat at least 5 or 6 small meals a day.
Always eat a high-protein breakfast.
Did you know that the peanuts offered on airlines are LESS fattening than the fat-free pretzels? It's true. Stay away from fat-free foods--they make your insulin levels do a yo-yo, and that makes you put on fat. Yuck. Worse, it sets the stage for adult-onset diabetes.

Do NOT eat white flour, bleached flour, enriched flour, or any other kind of wheat flour that is not whole wheat. The glycemic effects of such flours will work against you. Eat whole grain flours, and try to get a variety. Amaranth and soy are two good flours. Eat oat groats instead of oatmeal. In short, get your grains in the least-processed form you can. This holds true for everyone, regardless of genetics (unless you have a malabsorption problem). This one "trick" will help you keep your insulin level on an even keel, and that is paramount to diabetes prevention and management.

What also holds true for everyone is: drink lots of water! Fill a gallon jug twice a day, and make sure you drink all of it. Once you get as lean as you want to be, cut back to a single gallon if you want to. For added fat loss, drink chilled (but not super cold) water. Sodas do not count. Such beverages are extremely unhealthy, for reasons I won't cover here. However, I will say that if you want to get osteoporosis, soft drinks are for you. Soft drinks make for soft bones.

Learn about insulin management. Make a trip to your library and get a book on the glycemic index. Also, look for Ann Louise Gittleman's book,"Your Body Knows Best." She has other books that are good, too. If you can't find it at your library, you can order it via this hyperlink: Your Body Knows Best, $5.59. Be careful on these diet books: most of them are completely wrong.

Make sure to eat at least 5 or 6 small meals a day, rather than one big one. Doing so levels out your insulin and your blood sugar. Forget about that full feeling. If you find yourself overeating out of anxiety or boredom, fix the underlying problem--don't add to it by poor eating!

Exercise

You need to build muscle and burn fat. How many lean, muscular people do you know with diabetes? OK, so listen! Live the lean lifestyle, and you will be way ahead in the diabetes game.

Walking is a great exercise. Do it every day, and you'll raise your metabolic rate, as well as level out your blood sugar. This means you will burn extra calories even while you are sitting in front of your computer or sleeping in your bed! Look at the ways you save calories, and then spend them instead. Take the stairs instead of the elevator. Park away from the door, instead of up close. Use a pushmower instead of a riding mower. Pay attention to what you do and think of how you can burn more calories while doing it.

Source: Article written by Mark Lamendola, Mindconnection.com - who is genetically at risk for developing diabetes.

Type 2 Diabetes Symptoms

Up to two-thirds of people with type 2 diabetes have no symptoms. If present, the most common ones are:

increased production of urine (the body is trying to get rid of the excess glucose in the urine)
unusual thirst
tiredness (because the glucose is "going to waste" and not being converted into energy)
loss of weight
increased appetite
feeling sick
blurred vision
infections such as thrush or irritation of the genitals
Some people simply feel a bit unwell or assume they are just ageing.

Signs and tests

Type 2 diabetes is diagnosed with the following blood tests:

Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on two occasions.
Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/dL and accompanied by the classic symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.)
Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours.