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Diabetes affects how our bodies use blood sugar (glucose). Glucose is vital to our health because it's an important source of energy for the cells that make up our muscles and tissues. It's also our brain's main source of fuel.  To understand diabetes, first we must understand how glucose is normally processed in the body.

Glucose comes from two major sources: food and our liver.  Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.  Our liver stores and makes glucose - when our glucose levels are low, such as when we haven't eaten in a while, the liver breaks down stored glycogen into glucose to keep our glucose levels within a normal range.

Insulin is a hormone that comes from the pancreas, a gland situated behind and below the stomach.  The pancreas secretes insulin into the bloodstream where it circulates, enabling sugar to enter your cells.  Insulin lowers the amount of sugar in your bloodstream - as your blood sugar level drops, so does the secretion of insulin from your pancreas.

In prediabetes - which can lead to type 2 diabetes - and in type 2 diabetes, our cells become resistant to the action of insulin, and our pancreas is unable to make enough insulin to overcome this resistance.  Instead of moving into your cells where it's needed for energy, sugar builds up in your bloodstream.  Exactly why this happens is uncertain, although it's believed that genetic and environmental factors play a role in the development of type 2 diabetes.  Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight.

Researchers don't fully understand why some people develop prediabetes and type 2 diabetes and others don't. It's clear that certain factors increase the risk, however, including:

• Weight. The more fatty tissue we have, the more resistant our cells become to insulin.
• Inactivity. The less active we are, the greater our risk. Physical activity helps us control our weight, uses up glucose as energy, and makes our cells more sensitive to insulin.
• Family history. Our risk increases if a parent or sibling has type 2 diabetes.
• Race. Although it's unclear why, people of certain races - including black people, Hispanics, American Indians and Asian-Americans - are at higher risk.
• Age. Our risk increases as we get older. This may be because we tend to exercise less, lose muscle mass, and gain weight as we age. But type 2 diabetes is also increasing among children, adolescents and younger adults.
• Gestational diabetes. If we developed gestational diabetes when we were pregnant, our risk of developing prediabetes and type 2 diabetes later increases. If we gave birth to a baby weighing more than 9 pounds (4 kilograms), we're also at risk of type 2 diabetes.
• Polycystic ovary syndrome. For women, having polycystic ovary syndrome - a common condition characterized by irregular menstrual periods, excess hair growth and obesity - increases the risk of diabetes.
• High blood pressure. Having blood pressure over 140/90 millimeters of mercury (mm Hg) is linked to an increased risk of type 2 diabetes.
• Abnormal cholesterol and triglyceride levels. If we have low levels of high-density lipoprotein (HDL), or "good," cholesterol, our risk of type 2 diabetes is higher. Triglycerides are another type of fat carried in the blood. People with high levels of triglycerides have an increased risk of type 2 diabetes. Our doctors can let us know what our cholesterol and triglyceride levels are.

Long-term complications of diabetes develop gradually. The longer we have diabetes — and the less controlled our blood sugar - the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Possible complications include:

• Cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If we have diabetes, we're more likely to have heart disease or stroke.
• Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish our nerves, especially in our legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.  Left untreated, we could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.
  
• Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from our blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
• Eye damage (retinopathy). Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
• Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.
• Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
• Hearing impairment. Hearing problems are more common in people with diabetes.
• Alzheimer's disease. Type 2 diabetes may increase the risk of dementia, such as Alzheimer's disease. The poorer our blood sugar control, the greater the risk appears to be. Although there are theories as to how these disorders might be connected, none has yet been proved.
• Depression. Depression symptoms are common in people with type 1 and type 2 diabetes. Depression can affect diabetes management.

Type 1 diabetes can't be prevented. However, the same healthy lifestyle choices that help treat prediabetes, type 2 diabetes and gestational diabetes can also help prevent them:

• Eat healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains. Strive for variety to prevent boredom.
• Get more physical activity. Aim for 30 minutes of moderate physical activity a day. Take a brisk daily walk. Ride your bike. Swim laps. If you can't fit in a long workout, break it up into smaller sessions spread throughout the day.
• Lose excess pounds. If we're overweight, losing even 7 percent of your body weight - for example, 14 pounds if you weigh 200 pounds can reduce the risk of diabetes.  Don't try to lose weight during pregnancy, however. Talk to your doctor about how much weight is healthy for you to gain during pregnancy.  To keep our weight in a healthy range, focus on permanent changes to our eating and exercise habits. Motivate ourselves by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.
  

Sometimes medication is an option as well. Oral diabetes drugs such as Metformin (Glucophage, Glumetza, others) may reduce the risk of type 2 diabetes - but healthy lifestyle choices remain essential. Have blood sugar checked at least once a year to make sure type 2 diabetes hasn't developed.