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The disease and its forms
- diabetes mellitus
- Chronic disease in which blood glucose rises above normal, either because insulin is missing or because it does not act well enough.
- type 1 diabetes
- Form of diabetes in which the immune system destroys the beta cells of the pancreas, so the body's own insulin production almost disappears. Insulin treatment is needed from diagnosis.
- type 2 diabetes
- Form of diabetes in which the body produces insulin but does not use it efficiently, and production gradually declines over time. It is the most common form of diabetes.
- gestational diabetes
- Diabetes discovered for the first time during pregnancy, which usually goes away after birth.
- secondary diabetes
- Diabetes caused by another disease or by a treatment, for example by diseases of the pancreas or by corticosteroids.
- pancreatic (pancreatogenic) diabetes
- Secondary diabetes that appears after damage to the pancreas from pancreatitis, pancreatic surgery or other pancreatic diseases.
- LADA
- Autoimmune diabetes that starts in adulthood, progresses more slowly than classic type 1 diabetes and can be mistaken at first for type 2.
- MODY
- Group of rare forms of diabetes caused by a change in a single gene, usually passed down in families from one generation to the next.
- prediabetes
- Stage in which blood glucose is above normal but does not yet reach the threshold for diabetes. The risk of progressing to diabetes is increased.
- onset
- The moment when the disease becomes apparent and the diagnosis is made.
- remission ("honeymoon")
- Period at the start of type 1 diabetes treatment in which the remaining beta cells still produce insulin, so the need for injected insulin drops a lot.
- relapse after remission
- The end of the remission period, when the body's own insulin production falls again and insulin doses have to be increased.
- stages of type 1 diabetes
- The three stages of the disease. Stage 1 has autoantibodies with normal glucose, stage 2 adds mildly abnormal glucose, and stage 3 is the clinically manifest disease.
- long-term course
- The way the disease and the risk of complications change over the years under treatment.
Physiology and immunology
- pancreas
- Organ located behind the stomach that produces digestive enzymes and hormones, among them insulin and glucagon.
- beta cells
- The cells in the islets of Langerhans that produce insulin. In type 1 diabetes they are destroyed by the immune system.
- islets of Langerhans
- Small clusters of hormone-producing cells scattered through the pancreas, which contain the insulin-producing beta cells.
- insulin (the hormone)
- Hormone produced by the beta cells that lets glucose enter the cells and thereby lowers blood glucose.
- glucagon
- Hormone produced by the pancreas with the opposite effect to insulin. It raises blood glucose by releasing glucose from the liver.
- C-peptide
- Fragment released into the blood together with the body's own insulin, used as a measure of the remaining insulin production.
- glucose
- Simple sugar that circulates in the blood and is the main energy source of the cells.
- blood glucose
- The concentration of glucose in the blood, expressed in mg/dL or in mmol/L.
- autoimmunity
- Faulty reaction of the immune system, which attacks the body's own structures.
- autoimmune process
- The set of immune reactions directed against the beta cells, which gradually leads to their destruction.
- autoantibodies
- Antibodies directed against the body's own structures. In type 1 diabetes they appear months or years before symptoms and help with diagnosis.
- anti-GAD antibodies (GADA)
- Autoantibodies against the GAD enzyme of the beta cells, the most frequent ones at the onset of autoimmune diabetes in adults.
- anti-IA-2 antibodies (IA-2A)
- Autoantibodies against the IA-2 protein of the beta cells, used in the diagnosis of autoimmune diabetes.
- anti-ZnT8 antibodies (ZnT8A)
- Autoantibodies against the zinc transporter 8 of the beta cells.
- insulin autoantibodies (IAA)
- Autoantibodies against the body's own insulin, frequent especially in young children with type 1 diabetes.
- insulitis
- Inflammation of the islets of Langerhans produced by the autoimmune attack on the beta cells.
- immune system
- The set of cells and molecules that defend the body against infections. In autoimmune diseases it also attacks the body's own structures.
- T lymphocytes
- Immune cells with a central role in the destruction of beta cells in type 1 diabetes.
- cellular immunity
- The part of immunity carried out directly by cells, especially T lymphocytes, rather than by antibodies.
- genetic predisposition
- Inheriting gene variants that increase the risk of disease without making it inevitable.
- HLA
- The main system of immunity genes, called the human leukocyte antigen. Certain HLA variants significantly increase the risk of type 1 diabetes.
- molecular mimicry
- Resemblance between a microbial structure and one of the body's own, which can trick the immune system into attacking the body's own cells too.
- gut microbiome
- All the microorganisms living in the gut. It influences how immunity develops and is studied as a factor in type 1 diabetes.
- environmental factors
- Elements outside the genes, such as infections or diet, that can contribute to triggering the disease.
- viral and bacterial infections
- Infections studied as possible triggers or accelerators of the autoimmunity of type 1 diabetes.
- enteroviruses
- Family of viruses common in children, studied as a possible trigger of the autoimmunity of type 1 diabetes.
- vitamin D
- Vitamin with a role in immunity and in bone health. Low levels have been associated with a higher risk of type 1 diabetes.
- nutritional factors
- Elements of early-life nutrition studied in relation to the risk of type 1 diabetes, for example the duration of breastfeeding or the age at which gluten is introduced.
- perinatal factors
- Circumstances around birth, such as birth weight or cesarean delivery, associated with small variations in the risk of type 1 diabetes.
- beta-cell preservation
- The strategies that try to keep the remaining beta cells alive, from early diagnosis to immune therapies.
- cortisol
- Hormone produced by the adrenal glands that raises blood glucose. More of it is released in stress and in illness, and corticosteroid treatment has the same effect.
- glycogen
- The form in which the body stores glucose, mainly in the liver and in muscle. The liver turns it back into glucose when blood glucose falls.
- adrenaline
- Hormone released quickly in stress and in hypoglycemia. It raises blood glucose and produces the warning symptoms of hypoglycemia: shaking, palpitations, sweating.
- gluten
- Protein found in wheat, barley and rye. It matters in type 1 diabetes because celiac disease, in which gluten damages the small intestine, is more common in these patients than in the general population.
Symptoms and onset
- polyuria
- Frequent and abundant urination, one of the classic signs of high blood glucose.
- polydipsia
- Intense and persistent thirst, which usually accompanies polyuria at the onset of diabetes.
- dehydration
- Excessive loss of water from the body, common at the onset of diabetes because of abundant urination.
- classic onset
- The disease setting in with the typical signs, that is intense thirst, frequent urination, weight loss and tiredness.
- silent (slow) onset
- The disease setting in without obvious symptoms, sometimes discovered only through tests or screening.
- onset with ketoacidosis
- Severe form of onset in which the diagnosis is made only once diabetic ketoacidosis has developed.
Laboratory and diagnosis
- fasting glucose
- Blood glucose measured in the morning after at least 8 hours without food. Values of 126 mg/dL (7.0 mmol/L) or higher, confirmed on a second test, establish the diagnosis of diabetes.
- random glucose
- Blood glucose measured at any time of day, regardless of meals. A value of 200 mg/dL (11.1 mmol/L) or higher, together with typical symptoms, establishes the diagnosis of diabetes.
- glycated hemoglobin (HbA1c)
- The percentage of hemoglobin that glucose has attached to. It reflects the average blood glucose of the last 2–3 months.
- estimated average glucose (eAG)
- The average blood glucose calculated from HbA1c, expressed in the same units as everyday glucose readings.
- OGTT
- The oral glucose tolerance test. It measures blood glucose before and 2 hours after a standard drink containing 75 g of glucose.
- diagnostic criteria
- The internationally agreed thresholds of blood glucose and HbA1c from which diabetes is diagnosed.
- screening
- Testing people without symptoms in order to discover the disease or its risk as early as possible.
- ketone bodies
- Substances produced by the liver when cells cannot use glucose and burn too much fat. Without insulin they build up dangerously.
- ketonemia
- The presence of ketone bodies in the blood, measurable with rapid tests.
- ketonuria
- The presence of ketone bodies in the urine, detectable with test strips.
- glycosuria
- The presence of glucose in the urine. It appears when blood glucose exceeds the renal threshold of about 180 mg/dL (10.0 mmol/L).
- serum creatinine
- Blood test that reflects kidney function and enters the eGFR calculation.
- AST (transaminase)
- Liver enzyme measured in the blood, used among other things in the FIB-4 score for liver fibrosis.
- ALT (transaminase)
- Liver enzyme measured in the blood together with AST, used in the same FIB-4 score for liver fibrosis.
- HDL cholesterol
- The cholesterol fraction that carries cholesterol from the vessel walls back to the liver. Higher values are usually desirable, which is why it is called "good cholesterol".
- LDL cholesterol
- The cholesterol fraction that builds up in the artery wall. Higher values raise the risk of heart attack and stroke, which is why it is called "bad cholesterol".
- platelets
- The blood cells involved in clotting. Their count enters the calculation of the FIB-4 score.
- eGFR
- The estimated glomerular filtration rate, that is the standard measure of kidney function, calculated from creatinine, age and sex.
- kidney function
- The kidneys' ability to filter the blood, monitored regularly in people with diabetes.
- liver fibrosis
- Gradual scarring of the liver. Its risk can be estimated noninvasively with the FIB-4 score.
Acute complications
- hypoglycemia
- A drop in blood glucose below 70 mg/dL (3.9 mmol/L). It causes shakiness, sweating, hunger and the need to eat fast-acting carbohydrates right away.
- severe hypoglycemia
- Hypoglycemia in which the person needs someone else's help to recover.
- hyperglycemia
- A rise in blood glucose above the target values.
- diabetic ketoacidosis
- Serious acute complication caused by lack of insulin, with a buildup of ketone bodies and acidification of the blood. It is a medical emergency.
- hypoglycemic coma
- Loss of consciousness caused by severe hypoglycemia.
- treatment of hypoglycemia
- Rapid correction of blood glucose with about 15 g of fast-acting carbohydrates, repeated if needed after 15 minutes.
- emergency glucagon
- Medicine that raises blood glucose quickly, used in severe hypoglycemia when the person cannot swallow.
Insulin therapy
- insulin therapy
- Treatment with insulin given from outside the body, indispensable in type 1 diabetes.
- basal insulin
- The long-acting insulin that covers the body's needs between meals and overnight.
- prandial insulin (bolus)
- The insulin given at meals to cover the carbohydrates eaten.
- rapid-acting insulin
- Insulin analog for meals that starts working in 10–20 minutes and lasts 3–5 hours.
- ultra-rapid insulin
- Mealtime analog with an even faster start, suited to injection right before the meal.
- long-acting insulin
- Basal insulin with a profile as flat as possible, covering about 24 hours or more. The slow analogs used today are glargine and degludec.
- intermediate-acting insulin (NPH)
- Human basal insulin lasting about 12–16 hours, used less often today than the slow analogs.
- human insulin
- Insulin identical to the one produced by humans, obtained through biotechnology. Its forms are regular insulin for meals and NPH as basal.
- insulin analogs
- Insulins slightly modified from human insulin to give a more convenient action profile, either faster or slower and more stable.
- basal-bolus regimen
- The treatment regimen that combines a basal insulin with meal and correction boluses, the closest to natural secretion.
- multiple daily injections
- Delivering the basal-bolus regimen through several injections a day with an insulin pen.
- insulin dose
- The amount of insulin given at one time, expressed in international units.
- insulin pen
- Pen-shaped injection device with an insulin cartridge and a dose selector.
- pen needle
- Short single-use needle attached to the pen for each injection.
- injection technique
- The correct way of giving insulin under the skin, which directly influences how it is absorbed.
- injection site rotation
- Systematically changing the injection site in order to prevent lipohypertrophy.
- lipohypertrophy
- Thickening of the fatty tissue at repeatedly injected sites, which makes insulin absorption unpredictable.
- insulin-to-carbohydrate ratio (ICR)
- The number of grams of carbohydrate covered by one unit of insulin, used to calculate the meal bolus.
- correction factor (ISF)
- The number of mg/dL by which one unit of insulin lowers blood glucose, used to calculate the correction dose.
- correction dose
- Extra insulin given to bring a high blood glucose back to target.
- insulin degludec
- Basal insulin with a very long action that covers more than 24 hours and is given once a day.
- insulin glargine
- Long-acting basal insulin, usually given once a day. It exists in two concentrations, which are not interchangeable without the doctor's instruction.
- teplizumab
- Monoclonal antibody that delays the move from stage 2 to stage 3 of type 1 diabetes, in people with autoantibodies and already altered blood glucose.
Glucose sensors
- glucose sensor
- Device worn on the body that measures glucose every few minutes, without repeated finger pricks.
- continuous glucose monitoring (CGM)
- Automatic measurement of glucose day and night with a sensor, showing the values and the trend.
- real-time sensor
- Sensor that automatically sends every value to the phone or receiver and can raise alarms on its own.
- intermittently scanned sensor
- Sensor that shows the value when the phone or the sensor reader is brought close to it.
- transcutaneous sensor
- Sensor with a thin filament inserted through the skin, usually worn for 7–15 days.
- implantable sensor
- Sensor placed completely under the skin through a minor procedure, with a working life of several months.
- interstitial fluid
- The fluid between the cells, where sensors actually measure glucose.
- sensor-to-blood lag
- The delay of a few minutes between the interstitial fluid value and blood glucose, visible mainly during rapid changes.
- calibration
- Adjusting the sensor against a finger-prick glucose reading. Modern sensors come factory-calibrated.
- warm-up period
- The interval after insertion during which the sensor does not yet show values.
- accuracy
- How close the sensor values are to the real blood glucose.
- adjunctive use
- Using the sensor only as additional information, with treatment decisions confirmed by a glucose meter.
- non-adjunctive use
- Using the sensor directly for dosing decisions, without confirmation by a glucose meter.
- integrated sensor (iCGM)
- Sensor certified to communicate safely with other devices, for example with automated pumps.
- interoperability
- The ability of sensors, pumps and algorithms from different manufacturers to work together.
- transmitter
- The part of the sensor that sends the values wirelessly to the phone or receiver.
- receiver
- Dedicated device that displays the sensor values, used instead of a phone.
- applicator
- The device with which the sensor is placed on the skin with a simple press.
- alarms
- The sensor's sound or vibration warnings at low, high or rapidly changing glucose.
- trend arrows
- The arrows on the display that show the direction and speed of change of glucose.
- glucose meter
- The classic device that measures blood glucose from a drop of blood from the finger.
- finger prick
- Collecting the drop of blood for the glucose meter with a lancing device.
- professional sensor
- Sensor placed in the clinic and worn for a short period, with the data analyzed by the doctor at the end.
- wear time
- The number of days a sensor keeps measuring after insertion, set by the manufacturer.
- data transmission and storage
- The path of the values from the sensor to apps and platforms, where the care team or family can also see them.
Insulin pumps
- insulin pump
- Device worn on the body that delivers rapid-acting insulin continuously under the skin and replaces multiple injections.
- tubed pump
- Pump carried in a pocket or on a belt, connected to the body by a thin tube and an infusion set.
- tubeless (patch) pump
- Small pump stuck directly on the skin and controlled remotely, with no external tube.
- basal insulin patch
- Patch-type device that delivers only basal insulin, at a constant rate.
- bolus patch
- Patch-type device that delivers only mealtime boluses, by pressing.
- implantable pump
- Pump placed surgically in the abdomen, which releases insulin inside the body. It is used rarely, in special situations.
- basal rate
- The small amount of insulin the pump delivers every hour, which replaces injected basal insulin.
- bolus
- The insulin dose delivered at one time, at a meal or for correction.
- infusion set
- The tubing and cannula assembly that carries insulin from the pump under the skin. It is changed every 2–3 days.
- cannula
- The very thin plastic or steel tube inserted under the skin, through which insulin enters.
- catheter
- The generic name for the tubing through which the pump delivers insulin.
- reservoir
- The container inside the pump that is filled with rapid-acting insulin.
- occlusion
- Blockage of the insulin flow in the tube or cannula, signaled by the pump alarm. Left untreated, it quickly leads to hyperglycemia and ketosis.
- continuous subcutaneous infusion
- The medical term for the uninterrupted delivery of insulin under the skin, carried out by the pump.
- hybrid closed loop
- System in which the algorithm automatically adjusts basal insulin according to the sensor values, while meal boluses remain up to the user.
- automated insulin delivery system
- The combination of pump, sensor and algorithm that adjusts insulin delivery on its own.
- mimicking natural secretion
- The goal of modern treatment, namely reproducing as faithfully as possible the way a healthy pancreas releases insulin.
Nutrition and lifestyle
- carbohydrates
- The nutrients in food that raise blood glucose directly, from simple sugars to starch.
- carbohydrate counting
- Estimating the grams of carbohydrate in each meal, the basis for calculating the bolus in type 1 diabetes.
- glycemic index
- A measure of how fast a food raises blood glucose, compared with pure glucose.
- portion
- The amount of food actually eaten, expressed in grams or in household measures.
- physical activity
- Any movement that uses energy. It usually lowers blood glucose and calls for adjusting doses or adding snacks.
- overweight
- Weight above the normal range, defined in adults by a BMI of 25 kg/m² or more.
Scores and calculators
- body mass index (BMI)
- The ratio of weight to the square of height, used to classify weight in adults.
- eGFR CKD-EPI 2021
- The current standard formula for estimating kidney function in adults, from creatinine, age and sex.
- Schwartz formula
- The formula for estimating eGFR in children, which uses height and creatinine.
- FIB-4
- Score calculated from age, transaminases and platelets, which estimates the risk of liver fibrosis.
- FINDRISC
- Validated questionnaire that estimates the risk of developing type 2 diabetes within the next 10 years.
- PREVENT
- A set of American Heart Association equations that estimates cardiovascular risk over 10 and over 30 years, using kidney function as well.
- PHQ-9
- A nine-question questionnaire about the last two weeks, used for orientation in depression. It does not make the diagnosis on its own.
- GAD-7
- A seven-question questionnaire about the last two weeks, used for orientation in anxiety. It does not make the diagnosis on its own.
- unit converter
- Tool that converts lab values between units, for example blood glucose between mg/dL and mmol/L.
- percentile
- The position of a value against a reference group of the same age and sex. The 50th percentile is the middle value of the group.
Epidemiology and psychology
- incidence
- The number of new cases appearing in a population over a period of time, usually one year.
- prevalence
- The total number of people living with the disease at a given moment in a population.
- mortality
- The frequency of deaths associated with the disease in a population, tracked to measure progress in care.
- life expectancy
- The average number of years left to live, estimated statistically. It is an indicator followed constantly in diabetes studies.
- stress
- The body's reaction to demands. Stress hormones raise blood glucose, and psychological stress interferes with daily self-care.
- psychological impact
- The emotional burden of a chronic disease, from exhaustion to anxiety, which deserves to be discussed openly with the care team.
- psychological support
- Specialized or community help for the emotional burden of diabetes.
- associated autoimmune diseases
- Other autoimmune diseases that are more frequent in people with type 1 diabetes, first of all autoimmune thyroiditis and celiac disease.
- autoimmune thyroiditis
- Autoimmune inflammation of the thyroid gland, the most frequent disease associated with type 1 diabetes.
- celiac disease
- Autoimmune intolerance to gluten, looked for periodically through blood tests in people with type 1 diabetes.
Chronic complications
- diabetic retinopathy
- Damage to the small vessels of the retina, caused by high blood glucose maintained over years. It is found by examining the back of the eye before it causes symptoms.
- diabetic neuropathy
- Damage to the nerves, most often in the feet, with numbness, tingling or pain. It can reduce sensation, so wounds go unnoticed.
- diabetic nephropathy
- Damage to the kidneys, followed through albumin in the urine and through the estimated glomerular filtration rate.
Oral medicines
- metformin
- Oral medicine used as the first choice in type 2 diabetes. It lowers the glucose the liver produces and does not by itself cause hypoglycemia.
- sulfonylureas
- Class of oral medicines used in type 2 diabetes that make the beta cells release insulin. They can cause hypoglycemia, unlike metformin.
Abbreviations
- ADA
- American Diabetes Association, the author of the annual standards of care.
- AST
- aspartate aminotransferase, a transaminase used in the FIB-4 score.
- CGM
- continuous glucose monitoring.
- CKD-EPI
- Chronic Kidney Disease Epidemiology Collaboration, the standard formula for calculating eGFR.
- DM
- diabetes mellitus.
- eAG
- estimated average glucose, calculated from HbA1c.
- EASD
- European Association for the Study of Diabetes.
- eGFR
- estimated glomerular filtration rate.
- FIB-4
- Fibrosis-4, the score that estimates the risk of liver fibrosis.
- FINDRISC
- Finnish Diabetes Risk Score, the type 2 diabetes risk questionnaire.
- GADA
- autoantibodies against glutamic acid decarboxylase (GAD).
- HbA1c
- glycated hemoglobin.
- carbs
- carbohydrates.
- HLA
- human leukocyte antigen.
- IA-2A
- autoantibodies against the IA-2 protein of the beta cells.
- IAA
- insulin autoantibodies.
- ICD-10
- International Classification of Diseases, 10th revision.
- iCGM
- integrated CGM, the integrated sensor certified for interoperability.
- ICR
- insulin-to-carbohydrate ratio.
- BMI
- body mass index.
- ISF
- insulin sensitivity factor, also called the correction factor.
- ISPAD
- International Society for Pediatric and Adolescent Diabetes.
- LADA
- latent autoimmune diabetes in adults.
- MODY
- maturity-onset diabetes of the young, monogenic diabetes with onset at a young age.
- NPH
- neutral protamine Hagedorn, the intermediate-acting human insulin.
- WHO
- World Health Organization.
- OGTT
- oral glucose tolerance test.
- IU
- international unit, the unit of measurement for insulin doses.
- ZnT8A
- autoantibodies against the zinc transporter 8.