Diabetes

Diabetes is a chronic, progressive disease caused by a lack of, or problems processing, the hormone insulin, leading to persistently high blood sugar. Around 90 to 95% of cases are Type 2 (chronic and caused by factors like diet and environment). The remainder are Type 1 diabetes (an autoimmune disorder).

As of 2021, diabetes claimed at least 6.7 million lives and continues to kill one person every five seconds. Nearly one in two adults with diabetes don't know they have the condition, which is expected to increase in prevalence from 537 million in 2021, to 783 million in 2045.

Glucose, the brain's preferred energy source, enters the bloodstream when the body breaks down consumed carbohydrates. To manage this increase in readily available energy, the body releases the hormone insulin, which allows glucose to enter and fuel our cells. Without insulin, glucose remains in the blood, causing health issues.

Diabetes causes the body to attack insulin-producing cells in the pancreas, causing a shortage or lack of insulin. This prevents the body from accessing and storing blood sugar—the brain and muscles' primary energy source. It's unclear what causes Type 1 diabetes, an incurable yet manageable chronic condition as of 2024.

Almost 90 to 95% of people with diabetes have Type 2 diabetes, occuring when the pancreas doesn't make enough insulin or the insulin fails to work correctly. Insulin malfunction causes the pancreas to crank out increasingly high amounts of the blood sugar-regulating hormone, leading to overwork and reductions in production.

Pregnant people worldwide are increasingly likely to develop gestational diabetes due to rising maternal ages and obesity rates. Gestational diabetes is associated with heavier fetal weight, congenital abnormalities, and perinatal mortality, which includes stillbirths and deaths of infants younger than seven days old.

The pancreas weighs about the same as a deck of cards and is smaller than the average adult human hand. This lopsided glandular organ controls blood sugar levels through insulin production and helps the body digest food by creating a neutralizing tonic filled with digestive enzymes.

High blood sugar levels in untreated diabetes roughen artery walls, increasing plaque buildup, heart disease, and high blood pressure risk. High levels also cause acid to build up in the bloodstream, potentially making the brain swell, the lungs fill with fluid, and the heart to beat arrhythmically—all fatal complications.

Blood sugar levels increase after a meal when the body starts turning food into usable fuel—sugars, proteins, and more—which are absorbed into the bloodstream through the intestines. Blood sugar levels rise, releasing insulin, and letting sugar in the blood be absorbed into hungry cells, thereby dropping blood sugar levels.

For centuries, Type 1 diabetes was fatal. The 1920s "discovery" of insulin netted two of its creators—Frederick Banting and his boss, John Macleod—a Nobel prize. Separately, the German doctor Georg Zuelzer synthesized an effective version of the life-saving drug years earlier but was interrupted by World War I.