Purely by chance, World Diabetes Day in 2025 (November 14) coincides with my own birthday, but I can’t claim that this has any special significance, since there are approximately 22 million people worldwide who share the same birthday. But it does give me a way to inject a personal story into what would otherwise be a dry, clinical explanation of why type 2 diabetes (T2D) is an increasingly important subject.
My family has been affected by diabetes across multiple generations in a direct line of descent, which supports the theory that genetics plays a significant role in the incidence of the disease. My father started showing symptoms of diabetes in his late forties. Unfortunately, therapies for controlling blood sugar levels at that time were fairly crude.
Before the mid-1990s, the only viable treatment options were lifestyle changes (mostly involving strict control of what and how much a patient could eat and drink) and daily injections of insulin. Oral options for treating T2D (sulfonylureas and metformin) only gained a foothold in the last two decades of the century, sadly, far too late to be used by my beloved Dad. First he lost a leg due to progressive gangrene (a common outcome of progressive and uncontrolled diabetes), then his vision deteriorated (high blood sugar causes glaucoma and macular degeneration), and finally we lost him at a relatively young age due to the way that high blood sugar negatively affected many of the functioning organs in the rest of his body, such as the kidneys and heart.
A short history of treatment options other than insulin for type 2 diabetes
Earlier versions of sulfonylureas yielded limited results, along with many serious side effects. Second-generation versions like Daonil (glyburide) and Glipizide are still being used today, but they were only added to the pharmacy basket in the US during the 1980s. These drugs work by stimulating the pancreas to release more insulin.
Metformin was used in Europe in the 1950s, but it was not approved in the US until 1994, after trials confirmed its safety. Metformin reduces glucose production in the liver and improves the body’s sensitivity to insulin.
From father to daughter
Next in the family line, I developed diabetes sometime in my early 20s, most likely starting with what’s called gestational diabetes, which is kicked off by pregnancy. In the majority of cases, women who develop gestational diabetes return to normal blood sugar levels a few months after birth, but when there is already a family history of diabetes, as in my case, the likelihood of persistence of the disease is much higher. In a few ways, I was luckier than my father, because the disease was detected much earlier, before it had done too much damage in my body, and because the treatment options from the very beginning were much better. Even so, life wasn’t easy, and unless I monitored my blood sugar levels daily, stuck strictly to the controlled diet, and took my medications without fail, there was always a danger that the disease would win.
The modern era of T2D treatment – 1990s to the present
The late 1990s and the first two decades of the 21st century saw the introduction of new drug classes, such as:
- Precose (alpha-glucosidase inhibitor), Prandin (meglitinide), and Actos (a thiazolidinedione).
- Januvia and Onglyza (DPP-4 inhibitors usually given in combination with metformin).
- Ozempic and Mounjaro (GLP-1/GIP receptor agonists)
- Farxiga and Jardiance (SGLT2 inhibitors.)
Many of these drugs have been prescribed for me, each with its own benefits and, unfortunately, some with unwanted side effects that were serious enough to require hospitalization. The stark answer is that there is no 100% guaranteed treatment for diabetes, and so far, there’s no cure!
The development of home blood glucose meters, continuous glucose monitors (CGMs), and self-injectable weekly dosing has significantly improved the management of the disease and improved my overall quality of life.
Along with other people affected or at risk of diabetes, I have found that asking questions and getting answers from trustworthy and trained sources can help. Here are the answers to some of the questions I have asked over the years.
Questions and answers about diabetes. 
Does drinking water lower blood sugar?
Water helps manage blood sugar because when a person is well-hydrated, the kidneys can filter out excess blood sugar, excreting it in urine. Insufficient water consumption can lead to dehydration, which can concentrate the blood, increasing blood sugar levels. Staying hydrated helps maintain blood volume and prevents this spike. Water is also essential for proper kidney function and removing waste products, including excess glucose.
Important points to remember:
- Avoid sugary drinks like soda and juice, because they can cause blood sugar levels to rise quickly. Rather choose plain water or other unsweetened drinks.
- Drink water throughout the day, even if not feeling thirsty, especially in a warm environment.
- Consult a doctor sooner rather than later if there are any concerns about blood sugar levels,
What is the new type of diabetes?
The newest officially recognized type of diabetes is type 5 diabetes, which was previously called malnutrition-related diabetes mellitus (MRDM). It is caused by severe, long-term undernutrition, especially during childhood, which impairs the body’s ability to produce enough insulin. Unlike other forms of diabetes, type 5 is a distinct condition characterized by severe insulin deficiency but not insulin resistance.
In type 1 diabetes, the immune system destroys insulin-producing cells, resulting in severe insulin deficiency. Type 2 diabetes is the most common form of the disease, in which the body becomes resistant to insulin and eventually may not produce enough insulin to keep up. In type 5, malnutrition harms the pancreas’s ability to produce insulin, but the cells are not resistant to it.
What worsens diabetes?
Diabetes is made worse by factors like poor diet, lack of sleep, illness, stress, and improper medication use. Staying hydrated, exercising regularly, and managing emotional stress are key to better control, while consuming too much processed food, sugar, or alcohol can significantly worsen blood sugar levels.
Taking too little insulin or diabetes medication, or not taking it as prescribed, can worsen the condition. Certain medications, like steroids, can also increase blood sugar.
What organ is most affected by diabetes?
While diabetes affects many organs, the pancreas is the one most involved in the disease because it’s the organ that produces insulin, the hormone that regulates blood sugar. However, high blood sugar from diabetes causes widespread damage to other organs, with the kidneys, heart, and eyes often being the most significantly impacted.
How does diabetes affect sleep?
Diabetes affects sleep through high and low blood sugar, increased need to urinate, and conditions like sleep apnea and nerve pain. Poor sleep can also worsen blood sugar control, creating a cycle that makes diabetes harder to manage.
Both high and low blood sugar can disturb sleep, which is what makes proper control of medication and diet so important. High blood sugar (hyperglycemia) causes frequent urination and increased thirst, leading to nighttime awakenings. Low blood sugar (hypoglycemia) can cause sweating, shaking, and confusion, which can wake you up and make it hard to fall back asleep.
Other side effects of high blood sugar include nerve damage, which can cause pain or a burning sensation in the arms, legs, or feet, particularly at night, making it difficult to get comfortable. People with diabetes are at a higher risk of sleep apnea (difficulties in breathing when sleeping), where breathing repeatedly stops and starts during sleep. This leads to poor sleep quality and can make blood sugar levels harder to manage. Restless Legs Syndrome is more common in people with diabetes, causing an uncontrollable urge to move the legs and disrupting sleep. There is also a link between diabetes and depression, which can cause fatigue and changes in sleep patterns.
