Coston Autry did not know he was diabetic.
“A lot of the symptoms of its development can be easily confused with symptoms of someone just growing up. I lost a lot of weight. I was constantly craving sweets. I had increased thirst and increased urination,” Autry says of that time in his teen years when he unknowingly began to show signs of diabetes.
Then, one night, he began to vomit and grew concerned. He went to an emergency room to learn he had diabetic ketoacidosis—a potentially life-threatening condition that is a result of high blood sugar, low blood PH, and high keto acid levels.
“I was diagnosed with type 1 diabetes and it profoundly changed my life,” says this Dartmouth College rising sophomore.
Autry is among a growing number of people with diabetes. He is also co-founder of Dartmouth Diabetes Link, which is among those advocating for greater awareness about diabetes to help prevent serious complications.
“We really can prevent diabetes complications if we get started early and pay attention early. We have very good treatments now that are very effective,” says Dartmouth Health Endocrinologist Richard J. Comi, MD, the college club’s chief adviser.
How do you know if you have diabetes
Diabetes is a condition where the body either does not produce enough insulin, or the body's cells don't respond to the insulin produced, which leads to high blood sugar levels.
Common symptoms include:
- Increased thirst
- Frequent urination
- Extreme hunger
- Weight loss
- Fatigue
- Blurred vision
- Numbness or tingling in hands and feet
- Slow-healing wounds or infections
- Frequent yeast infections
- Skin problems
The most common symptom is excessive urination. “Why is that? The way we're designed, our kidneys prevent sugar from getting in our urine if the (blood) sugar is less than 200. Once the (blood) sugar's over 200, you get sugar spilling into the urine that takes water with it and you wind up with frequent urination, especially overnight, with multiple urinations and thirst,” says Comi.
What are the main types of diabetes?
Diabetes has two primary types: type 1 and type 2.
Type 1 diabetes is an autoimmune disease. Most cases show up during puberty, as it did with Autry, but the disease can strike at almost any age.
“Their immune system has, for whatever reason, taken a dislike to their insulin cells and destroyed them all. They have no insulin, and they really would die without treatment,” says Comi.
“Type 2 diabetes is a far more complicated illness that tends to occur later in life—in the thirties or forties—and is brought up by obesity and weight gain and age," he explains. "Those people still make insulin—they just don't make enough— they also don't respond well to insulin.”
While type 1 diabetes itself is not genetic, auto-immune diseases do run in families. For that reason and more, genetics is still thought to play a significant role in the development of type 1.
The role of genetics in type 2 diabetes is less clear-cut.
“Type 2 diabetes does not have a single gene origin and yet it's heavily genetic, not unlike obesity, which often is part of type 2 diabetes. You can't find a single gene that causes it." says Comi. "It's believed to be kind of a summation of a bunch of small unusual or changes in certain genes that add up to type 2 diabetes.”
What other forms of diabetes are there?
Maturity-onset diabetes of the young (MODY) is a less common form of diabetes. “These people tend to develop diabetes in their teens. They don't have type 1 diabetes. They still make insulin. They also usually are not obese. They often have a single gene mutation that causes their disease. Why is that important? Most of them tend to have less risk of diabetes complications. We pick them up mainly by family history. There are blood tests for them,” says Comi.
“And then there's latent autoimmune diabetes of adults (LADA). I like to think of that as type 1 and a half,” explains Comi, who says that people with LADA tend to be of normal weight and don’t have total insulin deficiency. But they do need to supplement their insulin.
Comi also points out that people can have hybrid forms and that diabetes is often not standalone.
People with type 2 diabetes may also have hypertension, lipid disorders, cardiovascular-related conditions, microvascular conditions, and depression.
Eating disorders are common in individuals with type 1 diabetes, particularly among young women.
How many people have diabetes?
The U.S. Centers for Disease Control and Prevention (CDC) reports that in 2021 an estimated 38.4 million people had the disease, which comprised 11.6% of the total U.S. population. 352,000 of those were people younger than 20-years-old. Some 8.7 million adults aged 18 years or older were unaware they had the disease.
And the numbers are anticipated to continue to rise, which is drawing more concern. The World Health Organization (WHO) reports that the number of adults living with diabetes globally has more than quadrupled since 1990 and now surpasses 800 million.
But while experts say the rise in type 2 diabetes reflects a mixture of factors including an increase in obesity rates, availability of unhealthy food, more sedentary lifestyles and even economic hardship, the increase in type 1 diabetes seems to have no clear or single explanation.
What is treatment?
Comi, however, stresses that especially when caught early, diabetes can be treated, minimizing the risk of complications.
But treatment needs to be tailored to the type of diabetes and the individual.
“Type 1’s, of course, need insulin. Type 2’s often, but not always, need insulin. And the MODY’s and the LADA’s sometimes, but not always, need insulin,” says Comi.
Medication also varies. For example, people with MODY often can be treated with oral medication, says Comi. “LADA tends to not respond really well to oral medicines.”
“It’s not a one-size-fits-all treatment for diabetes. It's often a matter of trying different treatments and seeing which forms affect that patient the best, and that's especially true in type 2 diabetes where it's not a single gene disorder,” he says.
The importance of education
Diabetes is a self-care disease, stresses Comi. “The doctor does not take care of your diabetes. You do. It's not that you go to the doctor, get a pill and leave. It's really a matter of diabetes education.”
A doctor can help you learn how to best address your diabetes, as can organizations like the American Diabetes Association and Breakthrough T1D.
“But if you have diabetes, making sure you see a diabetes educator, not just doctors, is actually very, very important to do,” says Comi. Your doctor can help you find educators.
It is also important to be aware that a single medication, diet, or form of exercise is not a cure-all. Having diabetes requires daily management.
“I'm making a lot more decisions regarding my health,” says Autry. “I'm a lot more cognizant of what I'm putting into my body and more cognizant of small changes in my body, like what that could actually mean for my health. I'm a lot more intimately connected with searching for those signs on a daily basis."