The risk factors for type 1 diabetes are still being researched. However, having a family member with type 1 diabetes slightly increases the risk of developing the disease. Environmental factors and exposure to some viral infections have also been linked to the risk of developing type 1 diabetes.

Several risk factors have been associated with type 2 diabetes and include:
  • Family history of diabetes
  • Overweight
  • Unhealthy diet
  • Physical inactivity
  • Increasing age
  • High blood pressure
  • Ethnicity
  • Impaired Glucose Tolerance (IGT)*
  • History of gestational diabetes
  • Poor nutrition during pregnancy

Impaired Glucose Tolerance (IGT) is a category of higher than normal blood glucose, but below the threshold for diagnosing diabetes. Changes in diet and physical activity related to rapid development and urbanisation have led to sharp increases in the numbers of people developing diabetes.

Pregnant women who are overweight, have been diagnosed with Impaired Glucose Tolerance (IGT), or have a family history of diabetes are all at increased risk of developing Gestational diabetes (GDM). In addition, having been previously diagnosed with gestational diabetes or being of certain ethnic groups puts women at increased risk of developing GDM.

People with diabetes have an increased risk of developing a number of serious health problems. Consistently high blood glucose levels can lead to serious diseases affecting the heart and blood vessels, eyes, kidneys, nerves and teeth. In addition, people with diabetes also have a higher risk of developing infections. In almost all high-income countries, diabetes is a leading cause of cardiovascular disease, blindness, kidney failure, and lower limb amputation. Maintaining blood glucose levels, blood pressure, and cholesterol at or close to normal can help delay or prevent diabetes complications. Therefore, people with diabetes need regular monitoring.

  • Cardiovascular disease:
  • Affects the heart and blood vessels and may cause fatal complications such as coronary artery disease (leading to heart attack) and stroke. Cardiovascular disease is the most common cause of death in people with diabetes. High blood pressure, high cholesterol, high blood glucose and other risk factors contribute to increasing the risk of cardiovascular complications.

  • Kidney disease (diabetic nephropathy):
  • Caused by damage to small blood vessels in the kidneys leading to the kidneys becoming less efficient or to fail altogether. Kidney disease is much more common in people with diabetes than in those without diabetes. Maintaining near normal levels of blood glucose and blood pressure can greatly reduce the risk of kidney disease.

  • Nerve disease (diabetic neuropathy):
  • Diabetes can cause damage to the nerves throughout the body when blood glucose and blood pressure are too high. This can lead to problems with digestion, erectile dysfunction, and many other functions. Among the most commonly affected areas are the extremities, in particular the feet. Nerve damage in these areas is called peripheral neuropathy, and can lead to pain, tingling, and loss of feeling. Loss of feeling is particularly important because it can allow injuries to go unnoticed, leading to serious infections and possible amputations. People with diabetes carry a risk of amputation that may be more than 25 times greater than that of people without diabetes. However, with comprehensive management, a large proportion of amputations related to diabetes can be prevented. Even when amputation takes place, the remaining leg and the person's life can be saved by good follow-up care from a multidisciplinary foot team. People with diabetes should regularly examine their feet.

  • Eye disease (diabetic retinopathy):
  • Most people with diabetes will develop some form of eye disease (retinopathy) causing reduced vision or blindness. Consistently high levels of blood glucose, together with high blood pressure and high cholesterol, are the main causes of retinopathy. It can be managed through regular eye checks and keeping glucose and lipid levels at or close to normal.

  • Pregnancy complications:
  • Women with any type of diabetes during pregnancy risk a number of complications if they do not carefully monitor and manage their condition. To prevent possible organ damage to the fetus, women with type 1 diabetes or type 2 diabetes should achieve target glucose levels before conception. All women with diabetes during pregnancy, type 1, type 2 or gestational should strive for target blood glucose levels throughout to minimize complications. High blood glucose during pregnancy can lead to the foetus putting on excess weight. This can lead to problems in delivery, trauma to the child and mother, and a sudden drop in blood glucose for the child after birth. Children who are exposed for a long time to high blood glucose in the womb are at higher risk of developing diabetes in the future

What causes Hyperglycaemia or high blood glucose?

High blood glucose can result when food, activity and insulin or other medication are not balanced. High blood glucose may happen when you are ill, pregnant or under stress.

The signs of high blood glucose include -
  • Thirsty and\or dry mouth
  • Glucose in the urine
  • Large urine volumes
  • Weakness and lethargy
  • Urinating more often
  • Blurred vision
  • Weight loss

If you think you have high blood glucose, check your blood glucose levels. If you have type 2 diabetes, call or see your doctor. If you have type 1 diabetes, test your urine for ketones and seek medical advice immediately if ketones are present.

A temporary high blood glucose level does not require any emergency measures at all. Always check for ketones in the urine. The absence of urine ketones means that the cells are not starved. If you feel well, measure the blood glucose level again before your next meal and if necessary, add another 1-2 units of short acting insulin to your pre-meal dose if levels are still high.

This is a severe condition caused by a lack of insulin or an increase of stress hormones. Ketones are dangerous acids which the body produces when there is not enough insulin and the body breaks down fat for fuel. The body will try to get rid of the ketones by excreting them in the urine. Another way to excrete ketones is in the form of acetone via exhalation through the lungs, causing a fruity odour on the breath.

People with type 1 should always test their urine for ketones if they feel their blood glucose is too high or if they are ill. These are some of the symptoms of ketoacidosis:

  • Nausea, vomiting
  • Tiredness and weakness
  • Abdominal pain
  • Heavy breathing, acetone odor
  • Pain in the chest or side, respiratory distress
  • Unconsciousness
  • Diabetes coma

Ketoacidosis is an extremely serious condition which can lead to seizures, coma and even death and requires urgent medical attention. Ketoacidosis can occur at the onset of diabetes or if you are completely without insulin for 12-24 hours. It can also occur when you take your ordinary doses but your body needs more insulin, for example when you have an infection and are ill, especially if you have a fever.

This condition only occurs in people treating their diabetes with medication. This is a condition in which blood glucose levels drop too low (generally below 3.5mmol/l). Symptoms include irritability, numbness in the arms and hands, sweating, confusion, extreme hunger, shakiness or dizziness. It should be treated immediately by eating or drinking a simple sugar such as a glucose sweet, Super C or sugary cold drink followed by a sandwich or other form of carbohydrate. If left untreated, this condition can become severe and lead to unconsciousness.

  • Not eating enough food.
  • Missing or delaying a meal.
  • Exercising without taking the necessary precautions.
  • Taking too much medication - insulin and\or diabetes tablets.
  • Drinking alcohol.

Note the symptoms you are feeling, and this will help you to identify low blood glucose in the future. People react differently to a low blood glucose level.

You may feel:
  • Hungry
  • Shaky or light headed
  • Nervous or irritable
  • Sweaty
  • Weak
  • Your heart beats at a faster rate
  • Confused
  • A numbness or tingling in your tongue or lips
  • Unusual behaviour and\or mood swings
  • Have a headache
  • Be unusually sleepy

REMEMBER - Some people do not have early warning signs of hypoglycemia. These individuals must check their blood glucose levels more often to avoid this condition. It is especially important for all people with diabetes to check their levels before driving a car or partaking in a strenuous or potentially dangerous activity.

Check your blood glucose. If you do not have your meter with you, treat the symptoms anyway. It is better to be on the safe side. Chocolate bars raise the blood glucose very slowly and should not be used to treat hypoglycemia.

Treat with an easy to eat, quickly absorbable form of sugar, such as -

  • 3 Glucose sweets
  • 125 ml regular (non-diet) cold drink
  • 3 teaspoons of honey

Always follow up with at least 15gm or more slowly absorbed carbohydrate such as a cheese or peanut butter sandwich or five or six high fibre biscuits such as ProVita.

If your blood glucose drops very low you may become confused and disorientated, lose consciousness or have a seizure. You will need assistance from another person. Make sure you always wear an identification bracelet which alerts helpers that you have diabetes. Talk to your doctor or educator about prevention and emergency treatment for severe low blood glucose.