Gestational diabetes develops during pregnancy in women who don’t have diabetes. It usually develops in the third trimester (between 24 and 28 weeks) and typically disappears after the baby is born.

The risk factors that increase the chances are:

• Family history of gestational diabetes
• Overweight or obese
• Polycystic ovary syndrome
• Have had a large baby weighing over 4kg
• Causes of gestational diabetes may also be related to ethnicity. Some ethnic groups have a higher risk of gestational diabetes.

Gestational diabetes typically doesn’t have any symptoms. Your medical history and whether you have any risk factors may suggest to your doctor that you could have gestational diabetes, but you’ll need to be tested to know for sure.

Gestational diabetes is much like prediabetes when it comes to treatment, if healthy eating and being active aren’t enough to manage your blood glucose, your doctor may prescribe oral medication or insulin.

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Prediabetes is when blood glucose levels are higher than normal, but not high enough yet to be diagnosed as Type 2 diabetes. 

Prediabetes includes the conditions: impaired fasting glucose and impaired glucose tolerance. These describe levels of blood glucose that are higher than normal but not yet in the diabetic range. These higher glucose levels are associated with a significantly higher risk of developing cardiovascular disease as well as progression to diabetes.

Prediabetes doesn’t usually have any signs or symptoms and it’s concerning that in many instances prediabetes is detected when tests are done to investigate another complaint.

Increased body weight is the greatest risk for developing prediabetes. It’s also more frequent in older populations and those with a family history of diabetes. 

Certain ethnicities have a higher incidence and in South Africa, our Indian community has a particular increased risk. Women with a history of gestational diabetes and polycystic ovary syndrome may develop prediabetes or diabetes as well.

Lifestyle interventions, like weight loss and exercise, are best to manage prediabetes. It’s recommended that medications be considered in people who haven’t reversed their prediabetes diagnosis with lifestyle alone or in individuals who are considered very high-risk of progressing to diabetes.

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Type 2 diabetes is the most common, accounting for around 90% of all diabetes cases.

Type 2 diabetes is caused by insulin resistance, where the body doesn’t fully respond to insulin. Because insulin can’t work properly, blood glucose levels keep rising, releasing more insulin. For some, this can eventually tire the pancreas, resulting in the body producing less and less insulin, causing even higher blood glucose levels.

It’s most commonly diagnosed in older adults, but is increasingly seen in children, adolescents and younger adults due to rising levels of obesity, physical inactivity and poor diet.

There are more risk factors that are linked to Type 2 diabetes: 

• Family history of diabetes 
•  Overweight
• Unhealthy diet
• Physical inactivity
• Increasing age
• High blood pressure
• Ethnicity
• Impaired glucose tolerance 
• History of gestational diabetes
• Poor nutrition during pregnancy

A healthy lifestyle which includes a balanced diet, regular physical activity, not smoking, and maintaining a healthy body weight are all elements to manage Type 2 diabetes. At diagnosis, all people with Type 2 diabetes are prescribed metformin, a tablet that helps control glucose production in the liver. If lifestyle and metformin don’t achieve good glucose control, more medications will be added. 

It’s important to be aware that diabetes is a progressive disease and eventually the pancreas will not produce enough insulin. At this point, insulin injections will be required. The rate of progression of diabetes is influenced by genetics as well as lifestyle and oral medications used. It’s often possible to keep the pancreas working for many years. 

Symptoms

• Excessive thirst and dry mouth
• Frequent urination
• Lack of energy, tiredness
• Slow-healing wounds
• Recurrent infections of the skin
• Blurred vision
• Tingling or numbness in hands and feet

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Around 10% of all people with diabetes have Type 1.

Type 1 diabetes is an autoimmune disease where the body’s defence system attacks the cells that produce insulin. As a result, the body produces very little or no insulin. The exact causes are not yet known but are linked to a combination of genetic predisposition (with or without a family history) and environmental factors. Some viral infections, this seems to include COVID-19, as well as environmental toxins have been implicated. These factors seem to trigger the immune system that is already programmed to incorrectly attack the insulin producing cells of the pancreas.

Type 1 diabetes can affect people at any age, but usually develops in children or young adults. Treatment includes daily injections of insulin to control blood glucose levels. 

Symptoms

• Abnormal thirst and dry mouth
• Sudden weight loss
• Frequent urination
• Lack of energy, tiredness
• Constant hunger
• Blurred vision
• Bed-wetting

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