CARBOHYDRATES

Carbohydrates are macronutrients and are one of the three main ways by which our body
obtains its energy. They are called carbohydrates as they comprise carbon, hydrogen and
oxygen at their chemical level. Carbohydrates are essential nutrients which include sugars,
fibers and starches. They are found in grains, vegetables, fruits and in milk and other dairy
products. They are the basic food groups which play an important role in a healthy life.

The food containing carbohydrates are converted into glucose or blood sugar during the process
of digestion by the digestive system.

Our body utilizes this sugar as a source of energy for the cells, organs and tissues. The extra
amount of energy or sugar is stored in our muscles and liver for further requirement. The term
‘carbohydrate’ is derived from a French term ‘hydrate de carbone‘ meaning ‘hydrate of
carbon‘. The general formula of this class of organic compounds is Cn(H2O)n.

Structure:

The carbohydrates can be structurally represented in any of the three forms:

 Open chain structure.

 Hemi-acetal structure.
 Haworth structure.

Open chain structure – It is the long straight-chain form of carbohydrates.

Hemi-acetal structure – Here the 1st carbon of the glucose condenses with the -OH group of
the 5th carbon to form a ring structure.

Haworth structure – It is the presence of the pyranose ring structure.

Classification of Carbohydrates

The carbohydrates are further classified into simple and complex which is mainly based on
their chemical structure and degree of polymerization.
Simple Carbohydrates (Monosaccharides, Disaccharides and
Oligosaccharides)

Simple carbohydrates have one or two sugar molecules. In simple carbohydrates, molecules
are digested and converted quickly resulting in a rise in the blood sugar levels. They are
abundantly found in milk products, beer, fruits, refined sugars, candies, etc. These
carbohydrates are called empty calories, as they do not possess fiber, vitamins and minerals.

Plants, being producers, synthesize glucose (C6H12O6) using raw materials like carbon dioxide
and water in the presence of sunlight. This process of photosynthesis converts solar energy to
chemical energy. Consumers feed on plants and harvest energy stored in the bonds of the
compounds synthesized by plants.

1. Monosaccharides

 The simplest group of carbohydrates and often called simple sugars since they cannot
be further hydrolysed.
 Colourless, crystalline solids that are soluble in water and insoluble in a non-polar
solvent.
 These are compound that possesses a free aldehyde or ketone group.
 The general formula is Cn(H2O)n or CnH2nOn.
 They are classified according to the number of carbon atoms they contain and also on
the basis of the functional group present.
  The monosaccharides thus with 3, 4, 5, 6, 7 … carbons are called trioses, tetroses,
pentoses, hexoses, heptoses, etc., and also as aldoses or ketoses depending upon
whether they contain aldehyde or ketone group.
 Examples: Glucose, Fructose, Erythrulose, Ribulose.

Glucose is an example of a carbohydrate monomer or monosaccharide. Other examples of

monosaccharides include mannose, galactose, fructose, etc. The structural organization of
monosaccharides is as follows:

Monosaccharides may be further classified depending on the number of carbon atoms:

(i)Trioses (C3H6O3): These have three carbon atoms per molecule. Example: Glyceraldehyde

(ii)Tetroses (C4H6O4): These monosaccharides have four carbon atoms per molecule.
Example: Erythrose.

Similarly, we have-

(iii) Pentoses,

(iv) Hexoses, and

(v) Heptoses

2. Disaccharides

Two monosaccharides combine to form a disaccharide. Examples of carbohydrates having two

monomers include- Sucrose, Lactose, Maltose, etc.
3. Oligosaccharides

Carbohydrates formed by the condensation of 2-9 monomers are called oligosaccharides. By

this convention, trioses, pentoses, hexoses are all oligosaccharides.

 Oligosaccharides are compound sugars that yield 2 to 10 molecules of the same or

different monosaccharides on hydrolysis.
 The monosaccharide units are joined by glycosidic linkage.
 Based on the number of monosaccharide units, it is further classified as a
disaccharide, trisaccharide, tetrasaccharide, etc.
 Oligosaccharides yielding 2 molecules of monosaccharides on hydrolysis is known as
a disaccharide, and the ones yielding 3 or 4 monosaccharides are known as
trisaccharides and tetrasaccharides respectively, and so on.
 The general formula of disaccharides is Cn(H2O)n-1and that of trisaccharides is
Cn(H2O)n-2 and so on.
 Examples: Disaccharides include sucrose, lactose, maltose, etc.
 Trisaccharides are Raffinose, Rabinose.

4. Complex Carbohydrates (Polysaccharides)

Complex carbohydrates have two or more sugar molecules; hence they are referred to as
starchy foods. In complex carbohydrates, molecules are digested and converted slowly
compared to simple carbohydrates. They are abundantly found in lentils, beans, peanuts,
potatoes, peas, corn, whole-grain bread, cereals, etc.

 They are also called “glycans”.

  Polysaccharides contain more than 10 monosaccharide units and can be hundreds of
sugar units in length.
 They yield more than 10 molecules of monosaccharides on hydrolysis.
 Polysaccharides differ from each other in the identity of their recurring
monosaccharide units, in the length of their chains, in the types of bond linking units
and in the degree of branching.
 They are primarily concerned with two important functions ie. Structural functions
and the storage of energy.
 They are further classified depending on the type of molecules produced as a result of
hydrolysis.
 They may be homopolysaccharidese, containing monosaccharides of the same type
or heteropolysaccharides i.e., monosaccharides of different types.
 Examples of Homopolysaccharides are starch, glycogen, cellulose, pectin.
 Heteropolysaccharides are Hyaluronic acid, Chondroitin.

Polysaccharides are complex carbohydrates formed by the polymerization of a large number

of monomers. Examples of polysaccharides include starch, glycogen, cellulose, etc. which
exhibit extensive branching and are homopolymers – made up of only glucose units.

1. Starch is composed of two components- amylose and amylopectin. Amylose forms the
linear chain and amylopectin is a much-branched chain.
2. Glycogen is called animal starch. It has a structure similar to starch, but has more
extensive branching.
 3. Cellulose is a structural carbohydrate and is the main structural component of the plant
cell wall. It is a fibrous polysaccharide with high tensile strength. In contrast to starch
and glycogen, cellulose forms a linear polymer.

Functions of Carbohydrates

 The main function of carbohydrates is to provide energy and food to the body and to
the nervous system.
 Carbohydrates are known as one of the basic components of food, including sugars,
starch, and fibre which are abundantly found in grains, fruits and milk products.
 Carbohydrates are also known as starch, simple sugars, complex carbohydrates and so
on.
 It is also involved in fat metabolism and prevents ketosis.
 Inhibits the breakdown of proteins for energy as they are the primary source of energy.
 An enzyme by name amylase assists in the breakdown of starch into glucose, finally
to produce energy for metabolism.

Biological Importance
• Carbohydrates are chief energy source, in many animals, they are instantsource of
energy. Glucose is broken down by glycolysis/ kreb's cycle to yield ATP.

 Glucose is the source of storage of energy. It is stored as glycogen in animalsand

starch in plants.
 Stored carbohydrates acts as energy source instead of proteins.

 Carbohydrates are intermediates in biosynthesis of fats and proteins.

 Carbohydrates aid in regulation of nerve tissue and is the energy source for
brain.
 Carbohydrates gets associated with lipids and proteins to form surfaceantigens,
receptor molecules, vitamins and antibiotics.
 They form structural and protective components, like in cell wall of plants and
microorganisms.
 In animals they are important constituent of connective tissues.

 They participate in biological transport, cell-cell communication and activationof

growth factors.
 Carbohydrates that are rich in fibre content help to prevent constipation.
  Also they help in modulation of immune system.

Properties:

Chemical Properties of Carbohydrates

 Osazone formation: Osazone are carbohydrate derivatives when sugars are reacted
with an excess of phenylhydrazine. eg. Glucosazone
 Benedict’s test: Reducing sugars when heated in the presence of an alkali gets
converted to powerful reducing species known as enediols. When Benedict’s reagent
solution and reducing sugars are heated together, the solution changes its color to
orange-red/ brick red.
 Oxidation: Monosaccharides are reducing sugars if their carbonyl groups oxidize to
give carboxylic acids. In Benedict’s test, D-glucose is oxidized to D-gluconic acid thus,
glucose is considered a reducing sugar.
 Reduction to alcohols: The C=O groups in open-chain forms of carbohydrates can be
reduced to alcohols by sodium borohydride, NaBH4, or catalytic hydrogenation (H2,
Ni, EtOH/H2O). The products are known as “alditols”.

Physical Properties of Carbohydrates

 Stereoisomerism – Compound shaving the same structural formula but they differ in
spatial configuration. Example: Glucose has two isomers with respect to the
penultimate carbon atom. They are D-glucose and L-glucose.
 Optical Activity – It is the rotation of plane-polarized light forming (+) glucose and
(-) glucose.
 Diastereo isomers – It the configurational changes with regard to C2, C3, or C4 in
glucose. Example: Mannose, galactose.
 Annomerism – It is the spatial configuration with respect to the first carbon atom in
aldoses and the second carbon atom in ketoses.

Sources of Carbohydrates

1. Simple sugars are found in the form of fructose in many fruits.

2. Galactose is present in all dairy products.
3. Lactose is abundantly found in milk and other dairy products.
4. Maltose is present in cereal, beer, potatoes, processed cheese, pasta, etc.
 5. Sucrose is naturally obtained from sugar and honey containing small amounts of
vitamins and minerals.

These simple sugars that consist of minerals and vitamins exist commonly in milk, fruits, and
vegetables. Many refined and other processed foods like white flour, white rice, and sugar,
lack important nutrients and hence, they are labelled “enriched.” It is quite healthy to use
vitamins, carbohydrates and all other organic nutrients in their normal forms.

Carbohydrate Foods

Eating too much sugar results in an abnormal increase in calories, which finally leads to
obesity and in turn low calories leads to malnutrition. Therefore, a well-balanced diet needs
to be maintained to have a healthy life. That is the reason a balanced diet is stressed so much
by dietitians.

Differences between the good and bad carbohydrates.

Good Carbohydrates Bad Carbohydrates

High in Nutrients Low in nutrients

Moderate in calories High in calories

Low in sodium and saturated fats High in sodium and saturated fats

Low in trans-fat and cholesterol High in trans-fat and cholesterol

They are complex carbs. For instance: Foods considered bad carbs rarely have any
Legumes, vegetables, whole grains, nutritional value. Some of the foods include white
fruits, and beans. flour, rice, pastries, sodas and processed foods.

Digestion and Absorption of Carbohydrates

From the Mouth to the Stomach

The mechanical and chemical digestion of carbohydrates begins in the mouth. Chewing, also
known as mastication, crumbles the carbohydrate foods into smaller and smaller pieces. The
salivary glands in the oral cavity secrete saliva that coats the food particles. Saliva contains the
enzyme, salivary amylase. This enzyme breaks the bonds between the monomeric sugar units
of disaccharides, oligosaccharides, and starches. The salivary amylase breaks down amylose
and amylopectin into smaller chains of glucose, called dextrins and maltose. The increased
concentration of maltose in the mouth that results from the mechanical and chemical
breakdown of starches in whole grains is what enhances their sweetness. Only about five
percent of starches are broken down in the mouth. (This is a good thing as more glucose in the
mouth would lead to more tooth decay.) When carbohydrates reach the stomach no further
chemical breakdown occurs because the amylase enzyme does not function in the acidic
conditions of the stomach. But mechanical breakdown is ongoing—the strong peristaltic
contractions of the stomach mix the carbohydrates into the more uniform mixture of chyme.

Figure: Salivary Glands in the Mouth

Salivary glands secrete salivary amylase, which begins the chemical breakdown of
carbohydrates by breaking the bonds between monomeric sugar units.
From the Stomach to the Small Intestine

The chyme is gradually expelled into the upper part of the small intestine. Upon entry of the
chyme into the small intestine, the pancreas releases pancreatic juice through a duct. This
pancreatic juice contains the enzyme, pancreatic amylase, which starts again the breakdown of
dextrins into shorter and shorter carbohydrate chains. Additionally, enzymes are secreted by
the intestinal cells that line the villi. These enzymes, known collectively as disaccharidase, are
sucrase, maltase, and lactase. Sucrase breaks sucrose into glucose and fructose molecules.
Maltase breaks the bond between the two glucose units of maltose, and lactase breaks the bond
between galactose and glucose. Once carbohydrates are chemically broken down into single
sugar units they are then transported into the inside of intestinal cells.

When people do not have enough of the enzyme lactase, lactose is not sufficiently broken down
resulting in a condition called lactose intolerance. The undigested lactose moves to the large
intestine where bacteria are able to digest it. The bacterial digestion of lactose produces gases
leading to symptoms of diarrhea, bloating, and abdominal cramps. Lactose intolerance usually
occurs in adults and is associated with race. Most people with lactose intolerance can tolerate
some amount of dairy products in their diet. The severity of the symptoms depends on how
much lactose is consumed and the degree of lactase deficiency.

Absorption: Going to the Blood Stream

The cells in the small intestine have membranes that contain many transport proteins in order
to get the monosaccharides and other nutrients into the blood where they can be distributed to
the rest of the body. The first organ to receive glucose, fructose, and galactose is the liver. The
liver takes them up and converts galactose to glucose, breaks fructose into even smaller carbon-
containing units, and either stores glucose as glycogen or exports it back to the blood. How
much glucose the liver exports to the blood is under hormonal control and you will soon
discover that even the glucose itself regulates its concentrations in the blood.
 Figure: Carbohydrate Digestion

Carbohydrate digestion begins in the mouth and is most extensive in the small intestine. The
resultant monosaccharides are absorbed into the bloodstream and transported to the liver.

Maintaining Blood Glucose Levels: The Pancreas and Liver

Glucose levels in the blood are tightly controlled, as having either too much or too little glucose
in the blood can have health consequences. Glucose regulates its levels in the blood via a
process called negative feedback. An everyday example of negative feedback is in your oven
because it contains a thermostat. When you set the temperature to cook a delicious homemade
noodle casserole at 375°F the thermostat senses the temperature and sends an electrical signal
to turn the elements on and heat up the oven. When the temperature reaches 375°F the
thermostat senses the temperature and sends a signal to turn the element off. Similarly, your
body senses blood glucose levels and maintains the glucose “temperature” in the target range.
The glucose thermostat is located within the cells of the pancreas. After eating a meal
containing carbohydrates glucose levels rise in the blood.
Insulin-secreting cells in the pancreas sense the increase in blood glucose and release the
hormone, insulin, into the blood. Insulin sends a signal to the body’s cells to remove glucose
from the blood by transporting it into different organ cells around the body and using it to make
energy. In the case of muscle tissue and the liver, insulin sends the biological message to store
glucose away as glycogen. The presence of insulin in the blood signifies to the body that
glucose is available for fuel. As glucose is transported into the cells around the body, the blood
glucose levels decrease. Insulin has an opposing hormone called glucagon. Glucagon-secreting
cells in the pancreas sense the drop in glucose and, in response, release glucagon into the blood.
Glucagon communicates to the cells in the body to stop using all the glucose. More specifically,
it signals the liver to break down glycogen and release the stored glucose into the blood, so that
glucose levels stay within the target range and all cells get the needed fuel to function properly.

Figure: The Regulation of Glucose

Carbohydrate metabolism:

Glycolysis

Glucose is the body’s most readily available source of energy. After digestive processes break
polysaccharides down into monosaccharides, including glucose, the monosaccharides are
transported across the wall of the small intestine and into the circulatory system, which
transports them to the liver. In the liver, hepatocytes either pass the glucose on through the
circulatory system or store excess glucose as glycogen. Cells in the body take up the circulating
glucose in response to insulin and, through a series of reactions called glycolysis, transfer some
of the energy in glucose to ADP to form ATP (Figure 2). The last step in glycolysis produces
the product pyruvate.
Glycolysis begins with the phosphorylation of glucose by hexokinase to form glucose-6-
phosphate. This step uses one ATP, which is the donor of the phosphate group. Under the action
of phosphofructokinase, glucose-6-phosphate is converted into fructose-6-phosphate. At this
point, a second ATP donates its phosphate group, forming fructose-1,6-bisphosphate. This six-
carbon sugar is split to form two phosphorylated three-carbon molecules, glyceraldehyde-3-
phosphate and dihydroxyacetone phosphate, which are both converted into glyceraldehyde-3-
phosphate. The glyceraldehyde-3-phosphate is further phosphorylated with groups donated by
dihydrogen phosphate present in the cell to form the three-carbon molecule 1,3-
bisphosphoglycerate. The energy of this reaction comes from the oxidation of (removal of
electrons from) glyceraldehyde-3-phosphate. In a series of reactions leading to pyruvate, the
two phosphate groups are then transferred to two ADPs to form two ATPs. Thus, glycolysis
uses two ATPs but generates four ATPs, yielding a net gain of two ATPs and two molecules
of pyruvate. In the presence of oxygen, pyruvate continues on to the Krebs cycle (also called
the citric acid cycle or tricarboxylic acid cycle (TCA), where additional energy is extracted
and passed on.
Krebs Cycle/Citric Acid Cycle/Tricarboxylic Acid Cycle

The pyruvate molecules generated during glycolysis are transported across the mitochondrial
membrane into the inner mitochondrial matrix, where they are metabolized by enzymes in a
pathway called the Krebs cycle. The Krebs cycle is also commonly called the citric acid cycle
or the tricarboxylic acid (TCA) cycle. During the Krebs cycle, high-energy molecules,
including ATP, NADH, and FADH2, are created. NADH and FADH2 then pass electrons
through the electron transport chain in the mitochondria to generate more ATP molecules.
The three-carbon pyruvate molecule generated during glycolysis moves from the cytoplasm
into the mitochondrial matrix, where it is converted by the enzyme pyruvate dehydrogenase
into a two-carbon acetyl coenzyme A (acetyl CoA) molecule. This reaction is an oxidative
decarboxylation reaction. It converts the three-carbon pyruvate into a two-carbon acetyl CoA
molecule, releasing carbon dioxide and transferring two electrons that combine with NAD+ to
form NADH. Acetyl CoA enters the Krebs cycle by combining with a four-carbon molecule,
oxaloacetate, to form the six-carbon molecule citrate, or citric acid, at the same time releasing
the coenzyme A molecule.

The six-carbon citrate molecule is systematically converted to a five-carbon molecule and then
a four-carbon molecule, ending with oxaloacetate, the beginning of the cycle. Along the way,
each citrate molecule will produce one ATP, one FADH2, and three NADH. The FADH2 and
NADH will enter the oxidative phosphorylation system located in the inner mitochondrial
membrane. In addition, the Krebs cycle supplies the starting materials to process and break
down proteins and fats.

To start the Krebs cycle, citrate synthase combines acetyl CoA and oxaloacetate to form a six-
carbon citrate molecule; CoA is subsequently released and can combine with another pyruvate
molecule to begin the cycle again. The aconitase enzyme converts citrate into isocitrate. In two
successive steps of oxidative decarboxylation, two molecules of CO2 and two NADH
molecules are produced when isocitrate dehydrogenase converts isocitrate into the five-carbon
α-ketoglutarate, which is then catalyzed and converted into the four-carbon succinyl CoA by
α-ketoglutarate dehydrogenase. The enzyme succinyl CoA dehydrogenase then converts
succinyl CoA into succinate and forms the high-energy molecule GTP, which transfers its
energy to ADP to produce ATP. Succinate dehydrogenase then converts succinate into
fumarate, forming a molecule of FADH2. Fumarase then converts fumarate into malate, which
malate dehydrogenase then converts back into oxaloacetate while reducing NAD+ to NADH.
Oxaloacetate is then ready to combine with the next acetyl CoA to start the Krebs cycle again.
For each turn of the cycle, three NADH, one ATP (through GTP), and one FADH2 are created.
Each carbon of pyruvate is converted into CO2, which is released as a byproduct of oxidative
(aerobic) respiration.

Oxidative Phosphorylation and the Electron Transport Chain

The electron transport chain (ETC) uses the NADH and FADH2 produced by the Krebs cycle
to generate ATP. Electrons from NADH and FADH2 are transferred through protein complexes
embedded in the inner mitochondrial membrane by a series of enzymatic reactions. The
electron transport chain consists of a series of four enzyme complexes (Complex I – Complex
IV) and two coenzymes (ubiquinone and Cytochrome c), which act as electron carriers and
proton pumps used to transfer H+ ions into the space between the inner and outer mitochondrial
membranes. The ETC couples the transfer of electrons between a donor (like NADH) and an
electron acceptor (like O2) with the transfer of protons (H+ ions) across the inner mitochondrial
membrane, enabling the process of oxidative phosphorylation. In the presence of oxygen,
energy is passed, stepwise, through the electron carriers to collect gradually the energy needed
to attach a phosphate to ADP and produce ATP. The role of molecular oxygen, O2, is as the
terminal electron acceptor for the ETC. This means that once the electrons have passed through
the entire ETC, they must be passed to another, separate molecule. These electrons, O2, and H+
ions from the matrix combine to form new water molecules. This is the basis for your need to
breathe in oxygen. Without oxygen, electron flow through the ETC ceases.
What is Diabetes Mellitus?

• All food that we eat is broken down into a sugar called glucose. Glucose is carried by
the blood to all the parts of the body to give energy. The hormone which helps glucose
move from the blood into the cells, is called INSULIN.
• DM is a metabolic disorder in which there are high blood glucose level over a prolonged
period.
• It is due to pancreas not providing enough insulin or cells fails to respond to insulin.
• Insulin helps to keep the blood sugar levels normal. In diabetes, the body does not
produce insulin or cannot use the insulin properly. The glucose builds up in the blood,
resulting in high blood glucose levels. Normally, a blood glucose level taken randomly
(that is at any time of the day) of over 140 mg/dl should lead to a suspicion of diabetes.
• Diabetes is a problem of INSULIN production and/or function and not a problem of
SUGAR.

The technical name for diabetes is diabetes mellitus. Another condition shares the term
“diabetes” — diabetes insipidus — but they’re distinct. They share the name “diabetes”
because they both cause increased thirst and frequent urination. Diabetes insipidus is much
rarer than diabetes mellitus.
What are the types of diabetes?

There are several types of diabetes. The most common forms include:

 Type 2 diabetes: With this type, your body doesn’t make enough insulin and/or your
body’s cells don’t respond normally to the insulin (insulin resistance). This is the most
common type of diabetes. It mainly affects adults, but children can have it as well.
 Prediabetes: This type is the stage before Type 2 diabetes. Your blood glucose levels
are higher than normal but not high enough to be officially diagnosed with Type 2
diabetes.
 Type 1 diabetes: This type is an autoimmune disease in which your immune system
attacks and destroys insulin-producing cells in your pancreas for unknown reasons. Up
to 10% of people who have diabetes have Type 1. It’s usually diagnosed in children
and young adults, but it can develop at any age.
 Gestational diabetes: This type develops in some people during pregnancy.
Gestational diabetes usually goes away after pregnancy. However, if you have
gestational diabetes, you’re at a higher risk of developing Type 2 diabetes later in life.

Symptoms and Causes

The severity of symptoms can vary based on the type of diabetes you have. These symptoms
are usually more intense in Type 1 diabetes than Type 2 diabetes.
What are the symptoms of diabetes?

Symptoms of diabetes include:

 Increased thirst (polydipsia) and dry mouth.

 Frequent urination (polyuria)
 Increased appetite (polyphagia)
 Fatigue.
 Blurred vision.
 Unexplained weight loss.
 Numbness or tingling in your hands or feet.
 Slow-healing sores or cuts.
 Frequent skin and/or vaginal yeast infections.

It’s important to talk to your healthcare provider if you or your child has these symptoms.

Additional details about symptoms per type of diabetes include:

 Type 1 diabetes: Symptoms of T1D can develop quickly — over a few weeks or
months. You may develop additional symptoms that are signs of a severe complication
called diabetes-related ketoacidosis (DKA). DKA is life-threatening and requires
immediate medical treatment. DKA symptoms include vomiting, stomach pains,
fruity-smelling breath and labored breathing.
 Type 2 diabetes and prediabetes: You may not have any symptoms at all, or you may
not notice them since they develop slowly. Routine bloodwork may show a high blood
sugar level before you recognize symptoms. Another possible sign of prediabetes is
darkened skin on certain parts of your body (acanthosis nigricans).
 Gestational diabetes: You typically won’t notice symptoms of gestational diabetes.
Your healthcare provider will test you for gestational diabetes between 24 and 28 weeks
of pregnancy.

What causes diabetes?

Too much glucose circulating in your bloodstream causes diabetes, regardless of the type.
However, the reason why your blood glucose levels are high differs depending on the type of
diabetes.
Causes of diabetes include:

 Insulin resistance: Type 2 diabetes mainly results from insulin resistance. Insulin
resistance happens when cells in your muscles, fat and liver don’t respond as they
should to insulin. Several factors and conditions contribute to varying degrees of insulin
resistance, including obesity, lack of physical activity, diet, hormonal imbalances,
genetics and certain medications.
 Autoimmune disease: Type 1 diabetes and LADA happen when your immune system
attacks the insulin-producing cells in your pancreas.
 Hormonal imbalances: During pregnancy, the placenta releases hormones that cause
insulin resistance. You may develop gestational diabetes if your pancreas can’t produce
enough insulin to overcome the insulin resistance. Other hormone-related conditions
like acromegaly and Cushing syndrome can also cause Type 2 diabetes.
 Pancreatic damage: Physical damage to your pancreas — from a condition, surgery
or injury — can impact its ability to make insulin, resulting in Type 3c diabetes.
 Genetic mutations: Certain genetic mutations can cause MODY and neonatal diabetes.

Long-term use of certain medications can also lead to Type 2 diabetes, including HIV/AIDS
medications and corticosteroids.

What are the complications of diabetes?

Diabetes can lead to acute (sudden and severe) and long-term complications — mainly due to
extreme or prolonged high blood sugar levels.

Acute diabetes complications

Acute diabetes complications that can be life-threatening include:

 Hyperosmolar hyperglycemic state (HHS): This complication mainly affects people

with Type 2 diabetes. It happens when your blood sugar levels are very high (over 600
milligrams per deciliter or mg/dL) for a long period, leading to severe dehydration and
confusion. It requires immediate medical treatment.
 Diabetes-related ketoacidosis (DKA): This complication mainly affects people with
Type 1 diabetes or undiagnosed T1D. It happens when your body doesn’t have enough
insulin. If your body doesn’t have insulin, it can’t use glucose for energy, so it breaks
down fat instead. This process eventually releases substances called ketones, which turn
 your blood acidic. This causes labored breathing, vomiting and loss of consciousness.
DKA requires immediate medical treatment.
 Severe low blood sugar (hypoglycemia): Hypoglycemia happens when your blood
sugar level drops below the range that’s healthy for you. Severe hypoglycemia is very
low blood sugar. It mainly affects people with diabetes who use insulin. Signs include
blurred or double vision, clumsiness, disorientation and seizures. It requires treatment
with emergency glucagon and/or medical intervention.

Long-term diabetes complications

Blood glucose levels that remain high for too long can damage your body’s tissues and
organs. This is mainly due to damage to your blood vessels and nerves, which support your
body’s tissues.

Cardiovascular (heart and blood vessel) issues are the most common type of long-term
diabetes complication. They include:

 Coronary artery disease.

 Heart attack.
 Stroke.
 Atherosclerosis.

Other diabetes complications include:

 Nerve damage (neuropathy), which can cause numbness, tingling and/or pain.
 Nephropathy, which can lead to kidney failure or the need for dialysis or transplant.
 Retinopathy, which can lead to blindness.
 Diabetes-related foot conditions.
 Skin infections.
 Amputations.
 Sexual dysfunction due to nerve and blood vessel damage, such as erectile
dysfunction or vaginal dryness.
 Gastroparesis.
 Hearing loss.
 Oral health issues, such as gum (periodontal) disease.

Living with diabetes can also affect your mental health. People with diabetes are two to three
times more likely to have depression than people without diabetes.
How is diabetes diagnosed?

Tests for type 1 and type 2 diabetes and prediabetes

 A1C test. This blood test, which doesn't require not eating for a period of time (fasting),
shows your average blood sugar level for the past 2 to 3 months. It measures the
percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red
blood cells. It's also called a glycated hemoglobin test.

The higher your blood sugar levels, the more hemoglobin you'll have with sugar
attached. An A1C level of 6.5% or higher on two separate tests means that you have
diabetes. An A1C between 5.7% and 6.4% means that you have prediabetes. Below
5.7% is considered normal.

 Random blood sugar test. A blood sample will be taken at a random time. No matter
when you last ate, a blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1
millimoles per liter (mmol/L) — or higher suggests diabetes.
 Fasting blood sugar test. A blood sample will be taken after you haven't eaten anything
the night before (fast). A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L)
is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is
considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests,
you have diabetes.
 Glucose tolerance test. For this test, you fast overnight. Then, the fasting blood sugar
level is measured. Then you drink a sugary liquid, and blood sugar levels are tested
regularly for the next two hours.

A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more
than 200 mg/dL (11.1 mmol/L) after two hours means you have diabetes. A reading
between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) means you have
prediabetes.