Diabetes Mellitus in Young Adults
Takeaways:
The two primary forms of diabetes mellitus in young adults, some of which start from childhood and adolescence, are T1D and T2D. Prediabetes is where blood glucose levels are considered higher than normal but do not meet the criteria for diabetes mellitus.
T1D is an autoimmune condition where the body mistakenly attacks insulin-producing cells. Scientists think T1D is caused by genes and environmental factors, such as viruses, that might trigger the condition.
While T2D is also linked to genetics, researchers believe lifestyle factors — e.g., consumption of high-calorie foods and a sedentary lifestyle — play a mitigating role in the condition’s progress.
Some young adults with diabetes may be symptomatic. However, symptoms and signs can include increased thirst and urination, unintended weight loss, and fruity-smelling breath.
Doctors often use blood sugar tests to diagnose diabetes in younger adults.
You suddenly notice that you are scarfing down your dinner and asking for more, more, more — only ever satisfied after you’ve cleaned out the entire pot. You might also be guzzling fluids seemingly non-stop.
Would you think something was wrong?
Chances are you'd probably shrug your shoulders and say, "Well, that's normal. I’m a young adult, developing, active and busy. How else would my body have enough fuel for the day?"
But here’s the thing. While the development of young adults often explain insatiable hunger and thirst, it’s also worth recognizing that there may be something more serious at play: diabetes.
Types of diabetes
Under normal circumstances, your body (and every other human body without diabetes, for that matter) keeps blood glucose — through various hormones, particularly glucagon and insulin — tightly controlled within a narrow range.
With diabetes, however, the body doesn’t make enough insulin and/or doesn’t use insulin properly.
Blood glucose levels then stay elevated. And if left uncontrolled, health complications such as kidney failure and blindness may result.
Type 1 and Type 2 diabetes mellitus
There are two primary types of diabetes mellitus:
Type 1 diabetes (T1D): An organ-specific autoimmune disease caused by the body’s (abnormal) destruction of pancreatic beta cells, which are the primary source of insulin. T1D is still relatively rare, affecting approximately 5% to 10% of people with diabetes. The condition is usually diagnosed in children and adolescents but can have its onset at any age. Although the exact cause of T1D is still unknown, researchers believe there is a strong genetic link with viruses and environmental factors (e.g., influenza B and whether the child was breastfed) acting as possible “triggers”.
Type 2 diabetes (T2D): T2D used to be called “adult-onset diabetes” because it was rarely seen in individuals under 40 — but not anymore, considering its meteoric-like rise in prevalence amongst children and adolescents globally. And that includes Singapore. A 2021 news article published in The Straits Times, for instance, reported that the KK Women’s and Children’s Hospital saw an increase in young patients with T2D. As for the cause of T2D in younger patients? Research indicates that it’s a complicated confluence of genetic (e.g., parental diabetes) and environmental factors (e.g., obesity, consumption of calorie-laden, ultra-processed foods, and certain medications).
Prediabetes
In most cases, T2D in young adults doesn't develop "overnight". Instead, what commonly happens first is prediabetes, a condition where blood glucose levels are considered higher than normal but do not meet the criteria for diabetes mellitus.
FYI, if you’re wondering, “higher than normal” levels (yet not qualifying for T2D) mean:
A fasting plasma glucose level of 100 to 125 mg/dL (5.6 to 6.9 mmol/L)
An HbA1c level of 5.7% to 6.4%
A two-hour post-load glucose level of 140 to 199 mg/dL (7.8 to 11.0 mmol/L)
Worryingly, research shows that as many as 70% of individuals with prediabetes will develop T2D within their lifetime. But there’s a silver lining. With early detection and healthier lifestyle habits, prediabetes is reversible.
Diabetes risk factors in young adults
Unfortunately, some young adults – and even children and adolescents – with prediabetes, T2D, and T1D are asymptomatic (i.e., no symptoms).
Meaning? Often, the only way you’d know if you have diabetes is through blood sugar tests, such as the random blood sugar test, fasting blood sugar test, HbA1c test, and oral glucose tolerance test — more on these later.
When should you test your blood sugar then?
Answer: when you have any of the following risk factors for:
T1D: Has a family history of T1D.
Prediabetes and T2D:
Your parent or sibling has type 2 diabetes
You are overweight
You are inactive
You have high blood pressure.
You have high levels of triglycerides
You have low levels of high-density lipoprotein (HDL) (also known as “good cholesterol”)
You smoke
Symptoms and signs of diabetes mellitus in young adults
Young adults with diabetes are sometimes asymptomatic (and especially so for those with prediabetes). However, there are instances where diabetes mellitus — T1D and T2D — could lead to the following signs and symptoms.
Type 1 diabetes mellitus
The main symptoms of T1D in young adults include:
Increased thirst and urination
Extreme hunger
Unintended weight loss
Fatigue
Irritability or behavior changes
Nausea and vomiting
Blurry vision
Fruity-smelling breath (a sign of diabetic ketoacidosis, an excessive accumulation of ketones in the blood and urine)
Type 2 diabetes mellitus
The main symptoms of T2D in young adults include:
Increased thirst and urination
Tiredness
Unexplained weight loss
Itching around the genitals, possibly with a yeast infection
Blurred vision
Slow healing of cuts and wounds
Fruity smelling breath
Dark patches of skin with a thick, velvety texture on the back of the neck, armpit, groin, or elsewhere (a sign of insulin resistance)
How is diabetes diagnosed?
The diagnosis is a two-part process:
Doctors first determine whether you have diabetes, then
Determine the type (i.e., differentiate between T1D and T2D)
The first part typically involves blood sugar tests (as previously mentioned):
Fasting glucose test: A measurement of your blood sugar levels after fasting for at least eight hours or overnight. A fasting blood sugar level ≥ 126 mg/dL (7.0 mmol/L) indicates diabetes mellitus.
Random glucose test: As its name suggests, this is when a doctor takes a blood sample from you at a random time. A blood sugar level ≥ 200 mg/dL (11.1 mmol/L) and the exhibition of symptoms suggest diabetes mellitus.
HbA1c test: HbA1c levels reflect your blood glucose levels over two to three months; the HbA1c test is usually considered more helpful in diagnosing T2D in asymptomatic younger adults. An HbA1c level ≥ 6.5% indicates diabetes mellitus.
Oral glucose tolerance test: In this test, you would have a blood sample drawn after having fasted for eight hours (or overnight) to determine your fasting glucose levels and then drink a special solution containing a large amount of glucose. Your blood sugar levels are tested two hours later — and if they are ≥ 200 mg/dL (11.1 mmol/L), you would be considered to have diabetes mellitus.
Note that the levels provided above apply only to diabetes mellitus. That is, T1D and T2D. Please refer to the previous section on prediabetes for blood glucose readings indicative of prediabetes.
Now, if you have diabetes, the doctor will then wish to distinguish T1D from T2D.
They could do so with blood tests that detect antibodies to various proteins produced by the pancreas' insulin-producing cells. Such antibodies are usually present in those with T1D and rarely in those with T2D.
Diabetes treatment options
Regardless of diabetes type (T1D, T2D, or prediabetes), doctors generally recommend making healthy food choices, losing weight if overweight, and exercising regularly to keep blood glucose levels as close to the normal range as possible.
But beyond that:
T1D: Insulin injections
T2D: Oral or injectable medications
Learn more about diabetes treatment in Singapore.
Preventing diabetes mellitus in young adults
There’s no known way to prevent T1D.
On the flip side, you can mitigate your risk for developing prediabetes and, in turn, T2D by living a less obesogenic lifestyle — so you maintain a healthy weight.
General strategies include:
Stay physically active: Although you are considered generally more active as a young adult, it is still recommended to do an hour or more of moderate-to-vigorous physical activity daily. You should also engage in muscle-and bone-strengthening exercises at least two times weekly (this could count toward the one-hour-daily minimum physical activity guideline). In addition to increasing your calorie burn, exercise has also been shown to boost the body's insulin sensitivity, lowering blood glucose levels.
Limit sugary foods and beverages: Bubble tea. Cookies. And all sorts of perennial sugar-packed favorites, from candies to cakes. You’d want to limit your consumption of these; they could cause harmful blood sugar swings and cause you to put on excess weight (which makes blood sugar control even more challenging). FYI, here are the best foods to eat for diabetes management.
That said, please do not go on extreme lifestyle changes, such as prolonged periods of intense physical activity and an extremely low-calorie diet.
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