Tag Archives: type 2 diabetes

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Type 2 diabetes drug Ozampic is facing shortage after approved by FDA as weight loss drug Wegovy

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Monday, January 16, 2023 1:57AM

Demand for a diabetes drug is on the rise, but the reason for that demand is being called into question.

The drug semaglutide was initially marketed under the name Ozempic to manage type 2 diabetes, but last year, it was approved by the FDA to be used for weight loss under the name Wegovy.

But now, the drug manufacturer Novo Nordisk is struggling to meet demand, which doctors say is creating a problem for type 2 diabetes patients.

RELATED: National Diabetes Awareness Month: Knowing signs and symptoms

“Our patients with diabetes are struggling just to get their medications to control their blood sugars and so we’re having to substitute other medications, increase their insulin requirements. People are gaining weight back from not being on these medications and so it really is becoming a problem for our patients that are dealing with type 2 diabetes. But then again, there is an epidemic of obesity, as well and we need to treat the obesity to prevent the diabetes in the first place,” said Dr. Disha Narang.

According to the CDC, more than 37 million Americans have diabetes 90% to 95% of them have type 2 diabetes.

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The Diabetes Drug Becomes A Viral Weight Loss Hit (Elon Musk Boasts Using It) Creating A Shortage

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Topline

Ozempic, the “worst kept secret in Hollywood,” has become increasingly popular due to its weight loss results—hyped even by billionaire Elon Musk—causing a shortage, even though it’s really meant for use in patients with type two diabetics.

Key Facts

Ozempic (known generically as semaglutide) is an injection used to lower blood sugar and hemoglobin A1C (the part of red blood cells with glucose attached) in type two diabetics; low A1C levels decrease diabetes complications like stroke, high blood pressure and blindness.

Manufactured by Novo Nordisk, the drug is a glucagon-like peptide-1 (GLP-1) receptor antagonist (a class of drugs used to treat diabetes) that was first approved for use in type two diabetics in 2017.

To lower blood sugar and A1C, the drug reacts with the body in three ways by helping the pancreas produce more insulin when blood sugar is high, slowing down the process of food leaving the stomach and stopping the liver from making and releasing too much sugar.

It’s meant to be injected once weekly in either the thigh, stomach or upper arm, with or without meals at any time of day, and patients typically start out taking a dose of 0.25 mg, though after four weeks it’s bumped up to 0.5 mg and then up to 1 mg if “more glycemic control is needed.”

Out of the more than 37 million Americans with diabetes, the vast majority—between 90% to 95%— have type two diabetes, according to the Centers for Disease Control and Prevention.

One of the side effects of Ozempic is weight loss, so some doctors have been prescribing the drug as an off-label use (the unapproved use of an approved drug) for weight loss in those without diabetes—Ozempic has not been approved by the FDA as a weight loss drug.

A study published in The New England Journal of Medicine found those who took Ozempic for 68 weeks, paired with a reduced calorie diet and a more active lifestyle saw an average change of body weight of 14.9% compared to a 2.4% change in the placebo group.

These findings have caused both obese people and those slightly overweight to request Ozempic prescriptions from their doctors.

Although Ozempic isn’t approved for weight loss, Wegovy, a higher-dose version of Ozempic, was approved for weight loss by the U.S. Food and Drug Administration in 2021 for obese or overweight adults with at least one weight-related condition like diabetes or high blood pressure.

News Peg

Wegovy and Ozempic are both listed by the FDA as two of almost 200 medications in a supply shortage, their recent rise in popularity for weight loss is believed to be the reason for their shortage. Francisco Prieto, a California-based physician told the Los Angeles Times that due to the shortage, his patients who take Ozempic have to “call multiple pharmacies and drive around town to see if it’s in stock,” with some still not being able to fill their prescriptions.

Chief Critic

According to the chief of clinical nutrition at the David Geffen School of Medicine at UCLA, Dr. Zhaoping Li, people should be wary of using diabetes drugs for weight loss. “The issue is that this is one of the tools in our box, it is not the end-all,” he told Variety. “The longest study done on these injections was conducted over less than two years. A lot of questions have not been answered.”

Side Effects

Some of the most common side effects that Ozempic causes are nausea, diarrhea, constipation and stomach pain. However, more serious side effects may occur, like possible thyroid tumors and cancer. According to Novo Nordisk, if someone takes the drug and feels a shortness of breath, a lump or swelling in the neck, trouble swallowing or hoarseness, they should contact their primary care doctor.

Tangent

Ozempic and other diabetes drugs like Mounjaro have made their way around Hollywood, with different celebrities and influencers boosting their weight loss as a result of the drugs. For example, when someone pointed out Elon Musk’s weight loss on Twitter in October, Musk responded that he achieved the look through fasting “and Wegovy.” His comment was met with a mixture of praise and criticism, with someone bringing up the drug shortages, claiming Musk didn’t “need it for weight loss, diabetics ACTUALLY need it.” According to Variety, the drugs have “devotees from every corner of the industry,” with actors, executives and agents alike glorifying them on Signal, an encrypted instant messaging service used to hold confidential conversations. Even just speculation is enough to draw controversy, and hashtag #ozempic has over 350 million views on TikTok. Thousands of videos are posted with the hashtag with people sharing their weight loss journeys and before and after pictures, with some attributing the drug’s rise in popularity on the app to its supply shortage.

Further Reading

What Is Ozempic and Why Is It Getting So Much Attention? (New York Times)

Hollywood’s Secret New Weight Loss Drug, Revealed: The Hype and Hazards of Ozempic (Variety)

TikTok trend wipes out Ozempic supply, leaving people with diabetes dizzy, scared (Los Angeles Times)



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Can eating raw foods reverse diabetes? Here’s what a nutritionist says | Health

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Raw food diet has become one of the latest diet trends among people looking to reverse chronic diseases like diabetes. It is basically the practice of eating foods that are uncooked or unprocessed and mostly consists of plant-based foods. While the diet is full of nutrients, retains many enzymes in the food, helps in losing weight and offers many other benefits, can it really help reverse diabetes? We asked an expert. (Also read: World Diabetes Day 2022: Doctors on tips to become diabetes-free and achieve remission)

Studies suggest that diabetes can be reversed by making certain lifestyle changes like your eating habits. Raw foods are usually considered healthy as they retain nutrients that are lost in the process of cooking and are also free of sugar or salt.

“Raw food diet or raw veganism is one of the diets which eliminates all of the processed and ultra-processed foods. Consisting mostly of fruits, vegetables, nuts, and seeds this diet is quite similar to veganism. Unlike a vegan diet, foods that are not cooked over 40- 48 degree Celsius are only eaten in a raw food diet. Foods like yogurt, kefir, kombucha and sauerkraut which are simply processed and fermented are also included in this diet,” says Dietitian Garima Goyal.

Foods undergoing intense processing with pesticides, fertilisers, and other preservatives are eliminated. Most of your fruit and vegetable juices and salads can also be eaten on a raw food diet.

Benefits of raw foods in diabetes

For diabetics, raw foods can be beneficial in different ways.

“Firstly, no processed foods implying no junk foods can help in achieving the goal of weight loss for overweight individuals. Ultimately, with this diet, you can stay away from all possible added sugars and preservatives which when consumed could cause blood sugar spikes. Consuming raw foods like minimally sauteed vegetables, fruits, nuts and seeds, vegetable juices, and salads is a rich source of fibre and can keep you satiated for a long time. They are digested slowly and ensure gradual blood sugar changes without sudden peaks. These unprocessed foods also retain many vitamins and minerals which could also be beneficial,” says Goyal.

But can raw foods really reverse diabetes

Goyal says that while the diet may look fancy, it cannot be your only solution to reverse diabetes. You need other elements of a healthy balanced diet for overall health.

“With the benefit of fibre and other nutrients, raw foods can be a part of your diet but you need not transform your entire diet. Cereals and pulses are staples of the Indian diet and without them and other cooked meals your diet would become deficient in calories, protein, and other vital nutrients,” says Goyal.

The dietitian says that reversal of diabetes is not possible by changing only the diet and missing out on other factors.

“For effective reversal, at the early stages, intensive lifestyle intervention which includes a healthy diet, exercise, and stress management is extremely important. Yet you cannot neglect your medications as well. It is important to be on par with all these the interventions for both reversal and controlling your diabetes,” says the expert.

Dietary supplements (which are excluded from raw food diet) like chromium, magnesium, and omega-3 fatty acids are also prescribed in certain cases.

“Reversal of diabetes may not be possible for all individuals, but for some, it is still an achievable goal. Instead of completely revamping your meals based on one particular trend, it is better to focus on a wholesome diet with adequate nutrients, regular exercise, stress management, and regular medications,” says Garima Goyal.

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Does covid trigger diabetes in children?

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Leah Wyckoff, a stay-at-home mom of four from West Chester, Ohio, knew there was something seriously wrong with her 8-year-old son Sam when her daughters—ages 7, 10, and 11—alerted her that his face looked scary.

He had been sick for about a day and vomiting frequently; the pediatrician had told her there was a stomach bug going around. Wyckoff thought he was probably just dehydrated. But when she went to look at him, she was shocked. He had dark circles under his eyes, and his mouth was so dry his lips kept sticking to his gums. “He looked like he had lost 10 pounds in like hours. I thought he was disappearing in front of my eyes,” she says.

A trip to the emergency room explained what was happening. Sam had severe diabetic ketoacidosis (DKA), a life-threatening condition where the body isn’t able to use sugar for energy, and starts breaking down fat at too fast a pace, causing the blood to become acidic. He had lost 15% of his body weight, and was quickly deteriorating.

“We think your son has Type 1 diabetes,” the doctors told Wyckoff and her husband. This was surprising, as he didn’t have any of the classic onset symptoms such as excessive urination or thirst, but the diagnosis was clear. Sam was admitted to the intensive care unit to be stabilized—and put in isolation.

At the hospital, he had also tested positive for covid.

The two things might be coincidental, the doctors told Wyckoff. Or they might not be. “They explained in the hospital that most likely something in his genetic makeup means he was more predisposed to developing Type 1 [diabetes] and covid was what brought the onset,” she says. “They said there are a couple of different viruses that can bring the onset and covid happens to be one of them.”

Sam Wyckoff isn’t the only child to be diagnosed with Type 1 diabetes at the same time as, or shortly after, covid. In fact, Type 1 diabetes is could be up to 77% more likely in children who have had covid, according to some preliminary studies.

Covid as a possible trigger of Type 1 diabetes 

Upticks of diabetes diagnoses in coincidence with covid-19 have been registered by several studies. A study done by the University of California, San Diego, found that from March 2020 and March 2021, 57% more children were admitted into the hospital with a diagnosis of Type 1 diabetes than were expected based on data from the previous years. Data analysis from the US Centers for Disease Control and Prevention (CDC), found an increased risk—ranging from 31% to 166% higher, depending on the body of data analyzed—of Type 1 diabetes diagnosis in patients under 18, 30 days after a covid infection. In Germany, the new diagnoses of Type 1 diabetes in children and adolescents increased significantly in 2020 and 2021, and studies from Norway and Finland have arrived at similar findings.

Most of this research is done through data analysis of hospitalization numbers and diagnoses, and is far from establishing any causation link between covid and diabetes. Many things could explain the numbers, says Sharon Saydah, a senior scientist at the CDC who worked on the diabetes study. It could be that covid triggers an autoimmune response that leads to diabetes; perhaps children who were predisposed to diabetes had more severe cases of covid, and were diagnosed with diabetes only after; or parents might be more vigilant with children who had covid, and quicker to recognize the signs of diabetes.

Wyckoff’s other children were tested for the four autoantibodies associated with Type 1 diabetes. Her eldest daughter, Audrey, was positive for all of them, and while she doesn’t have full-fledged diabetes yet, she is all but sure to develop it, making theirs one of the rare families in which more than one member has Type 1 diabetes. This points to the complicated nature of autoimmune diseases, and the roles that unrelated viruses may play in triggering their onset. The Epstein-Barr virus is believed to be the possible trigger of autoimmune conditions such as lupus and multiple sclerosis, and even the flu has been associated with the onset of Type 1 diabetes.

Whatever the cause, says Saydah, the association between covid and diabetes is important enough to demand further research to understand what is happening, and why.

How does diabetes work?

Diabetes is a disease in which the body doesn’t produce the hormone insulin, or does not respond to it appropriately. This results in a failure to absorb and use carbohydrates as energy, and in elevated levels of glucose in the blood. There are two types of diabetes. Type 1 is a condition in which the pancreas doesn’t have the ability to produce sufficient insulin for the metabolization of sugars. It is rare and chronic, managed through administration of synthetic insulin. It is overwhelmingly diagnosed in childhood, and accounts for almost all of the of diabetes diagnoses in children under age 10. Type1 diabetes is an organ-specific autoimmune disease, in which autoantibodies attack pancreatic beta cells, hindering their ability to produce insulin.

Type 2 diabetes happens when the body does not respond properly to insulin. It is a metabolic condition typically linked to lifestyle and diet, and it is usually diagnosed during or after adolescence. It’s very common—an estimated 10% of Americans have Type 2 diabetes, and one-in-three have pre-diabetes. The onset of Type 2 diabetes is usually slower than in Type 1, and insulin isn’t always needed as some cases can be managed with diet and lifestyle changes. In the vast majority of cases, Type 1 diabetes is diagnosed by age 10, while adult-onset diabetes is almost exclusively Type 2. In adolescence, diagnosing whether diabetes is Type 1 or 2 can be more challenging.

Studies have shown an increase in Type 2 diabetes in connection with covid, too. A study by the Colorado Children’s Hospital found a dramatic increase in youth-onset (under 21), Type 2 diabetes in 2020, about double the number they would ordinarily see. A broader review of data from 24 facilities confirmed it: there was a 77% increase in cases of Type 2 diabetes among youth (8- to 21-years-old) during the first year of pandemic.

Diabetes could be a long covid outcome

While increases in Type 2 diabetes diagnoses might be driven by lifestyle factors—the result of a more sedentary lifestyle during lockdowns, or a poorer diet—the increase in Type 1 diabetes suggests covid might be triggering an autoimmune response. “It could be due to the effects of the [covid] infection directly on organ systems involved in diabetes risk. It might be that covid is leading to diabetes through, say, direct attack on pancreatic cells,” says Saydah.

“Type 1 diabetes is thought to be an autoimmune disease and prior infections could trigger it, so we were not necessarily shocked that it would be increased following covid,” says, a professor of medicine at Case Western Reserve University and co-author of an electronic health data study that found an increase in the disease of nearly 80% among children under 10 who had covid. “However, it was increased even above other respiratory infections—so clearly, covid had had some kind of an association.”

The link between covid and Type 1 diabetes might be found in the autoimmune response. (In the absence of data on the type of diabetes, Davis’s research team picked the child’s age as an imperfect, but functional proxy for the type of diabetes, as most diagnoses before 10 years old are of Type 1.) “There are a lot of reports of increased autoimmune antibodies in patients who have covid, and since Type1 diabetes is thought to be an autoimmune disease, we thought that this might well provide a risk factor,” says Davis.

In a way, diabetes might fall into the still growing list of long-term consequences of covid. Autoimmune antibodies have been found in long covid patients, for instance, although the attack on pancreatic beta cells (and consequent diabetes) is particularly concerning because they don’t regenerate themselves like many other body cells.

What can parents do?

“This could be a big issue and it could be a driving health problem as the pandemic wears on,” says Davis, adding that there are many new aspects of the long tail of covid we are still struggling to understand.

In this case, follow-up studies are needed to tease out whether there is, in fact, a causal link between covid and Type 1 diabetes, and how it works—though it might take time before those questions are answered. “Those are very difficult studies and require a long-term commitment both on the part of the investigating physicians and on the part of the family,” says Davis. Another challenge, says Saydah, is finding a good control group, because Type 1 diabetes is a rare condition, and it’s difficult to predict what children will develop it, and then compare their situation with that of children who have had covid.

While scientists continue to investigate the link, parents and caregivers can take action, starting with vaccinating children to protect them from the most severe consequences of covid including, potentially, diabetes. “It is better to prevent the disease and everything that comes afterwards […] Vaccination does very well at that,” says Davis.”I can tell you that my grandchildren are all vaccinated.” Sam Wyckoff was in between his two doses of vaccine when he got covid, and it’s likely he wouldn’t have been infected had he completed the course. Yet so far, the uptake of covid vaccination in children has been abysmal: Just above 30% of children between ages 5 and 11 are vaccinated, and less than 10% of children under 5 have received at least one dose of vaccine.

Further, parents should monitor their children, and be especially vigilant in the weeks and months after they have had covid, even if vaccinated. Increased thirst and frequent urination, weight loss, and extreme fatigue can be signs of diabetes, and an early diagnosis helps avoid the risk of DKA, which can be deadly. “Parents of children who had covid should be aware of the different signs and symptoms of diabetes, so they can make sure that they get the care that they need,” says Saydah.

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Consumption of tea may lower the risk of getting type 2 diabetes: Study | Health

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Moderate use of black, green, or oolong tea is associated with a lower risk of acquiring type 2 diabetes, according to a systematic review and meta-analysis of 19 cohort studies involving more than 1 million adults from eight different countries. The research indicates that having at least four cups of tea per day is linked to a 17% lower risk of type 2 diabetes (T2D) over an average of ten years, according to findings presented at this year’s European Association for the Study of Diabetes (EASD) Annual Meeting in Stockholm, Sweden (19-23 September).

(Also read: Tea drinkers enjoy possible health benefits: Study)

According to main author Xiaying Li of Wuhan University of Science and Technology in China, “our results are intriguing because they imply that people can do something as easy as drinking four cups of tea a day to potentially lower their chance of acquiring type 2 diabetes.”

Because of the numerous antioxidant, anti-inflammatory, and anticarcinogenic components that tea contains, it has long been known that drinking tea frequently may be healthy, but the link between tea consumption and the risk of T2D has been less obvious. Cohort studies and meta-analyses that have been published so far have presented conflicting results.

To clarify the connection between tea drinking and future T2DM risk, researchers carried out a cohort study and a dose-response meta-analysis. First, they looked at 5,199 participants (2583 men and 2616 women; average age, 42) from the China Health and Nutrition Survey (CHNS), who were enrolled in 1997 and followed up within 2009 and had no prior history of T2D. The CHNS is a multicenter prospective study that examines inhabitants from nine provinces’ socioeconomic conditions as well as their physical and mental health.

Participants initially completed a food and drink frequency questionnaire and supplied details on lifestyle choices such regular exercise, smoking, and alcohol use. 2,379 (46%) participants reported drinking tea overall, and 522 (10%) persons had T2D by the conclusion of the trial. Researchers discovered that tea drinkers and non-drinkers had comparable risks of getting type 2 diabetes (T2D) after correcting for variables such as age, sex, and physical inactivity that are known to be associated with higher risk of T2D. And when patients who got diabetes during the first three years of follow-up were omitted or the results were broken down by age and sex, they did not significantly alter the findings.

The researchers then conducted a systematic evaluation of all cohort studies examining the relationship between tea consumption and the risk of T2D in adults (aged 18 or older) up until September 2021. The dose-response meta-analysis comprised 19 cohort studies totalling 1,076,311 participants from eight different nations. They investigated the potential effects of various tea consumption patterns (less than one cup per day, one to three cups per day, and four or more cups per day), gender (male and female), and research region (Europe and America, or Asia), on the risk of T2D.

Overall, the meta-analysis discovered a linear relationship between tea consumption and T2D risk, with each daily cup of tea lowering risk by about 1%. Adults who drank 1-3 cups of tea per day had a 4% lower risk of T2D than those who didn’t, while those who drank at least 4 cups per day had a 17% lower risk.

The relationships were shown regardless of the type of tea people drank, whether they identified as male or female, or where they resided, indicating that the quantity of tea taken may be more important than any other factor in explaining the associations. Our results imply that drinking tea is beneficial in lowering the risk of type 2 diabetes, but only at large levels (at least 4 cups a day), adds Li. However, more research is needed to pinpoint the precise dosage and processes underlying these observations.

She continues, “It is plausible that specific tea constituents, like polyphenols, may lower blood glucose levels, but it may need a significant quantity of these bioactive substances to be effective. It may also be the reason why, despite looking at higher tea intake, we did not discover a link between type 2 diabetes and tea drinking in our cohort analysis.

The same plant that is used to produce green and black teas is also used to manufacture oolong tea, a traditional Chinese beverage. The processing method makes a difference; oolong tea is partially oxidised whereas black tea is permitted to fully oxidise. Green tea is not allowed to oxidise substantially. Despite the significant results, the authors point out that as the research was observational, it cannot conclusively show that tea consumption decreased the incidence of T2D but rather provides evidence that it probably does.

The researchers also highlight a number of cautions, such as the fact that they relied on estimates of the amounts of tea consumed that were made subjectively, and that they cannot completely rule out the possibility that residual confounding from other lifestyle and physiological factors may have impacted the findings.

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This story has been published from a wire agency feed without modifications to the text. Only the headline has been changed.



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Diabetes: Warning signs that your blood sugar is out of control | Health

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Uncontrolled blood sugar levels over a period of time can lead to many potentially life-threatening complications. People who have diabetes even with their best efforts will have episodes when their blood sugar levels will go haywire, but with regular monitoring, medicines and proper diet, exercise, one can bring sugar levels in control most of the times. When your blood sugars are high your body is likely to warn you with a series of symptoms. If you feel tired constantly even after resting, your mood experiences change, your wounds take more time to heal than before, your vision starts feeling blurry or you experience frequent aches or pains, it may indicate that you need better diabetes management plan. (Also read: Diabetes: Signs that your blood glucose levels are too low)

Eating low GI foods, staying active, regular exercise and monitoring blood sugar levels generally do the trick but one should approach their doctor if things are not in control.

Karishma Shah, Nutritionist and Wellness expert in her recent Instagram post lists out high blood sugar signs that one should not ignore.

Weight loss even after normal diet

If a person suffering from diabetes loses weight even after having normal diet, this means the sugar levels are out of control as a lot of calories are lost in the urine.

Tired even after rest

When the level of glucose increases, its absorption by the body becomes difficult. It leads to extreme fatigue even after having good sleep or rest.

Slow healing of cuts, sores and infections

White blood cells which eliminate infection depend entirely on glucose because if the latter is higher there is slow response from them as well. This results in slow healing of blood gums, small cuts, sores and infections.

Your vision blurs

When the sugar level shoots up, the lens of the eye either shrinks or swells up causing blurry vision due to creation of little spots known as floaters.

Frequent pains

Other crucial symptoms of high glucose levels are frequent pain in shoulders, fainting, shortness of breath and discomfort in the chest, arms or jaw.

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Signs of Type 2 Diabetes: 10 Common Symptoms to Know

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People of certain races and ethnicities, including African Americans, Latinx, Native Americans, Pacific Islanders, and Asian Americans are also more likely to develop type 2 diabetes, although experts don’t fully understand all the reasons for this elevated risk.

What are the signs of type 2 diabetes?

Some signs of type 2 diabetes can be subtle, because the condition tends to develop slowly over time compared to type 1 diabetes, per the NIDDK. In fact, it may take several years for symptoms to pop up, so you may not realize you have the disease until it causes certain complications, like heart issues or blurry vision.

While having just one on this list isn’t a surefire indicator of the condition, pay attention to whether you’re experiencing several of these, Hien Tran, M.D., an endocrinologist with Texas Diabetes and Endocrinology, tells SELF. Simply having a dry mouth on its own may not be enough to prompt a doctor’s appointment, for example, but if that sign is paired with other symptoms on this list and you also have any of the risk factors mentioned above, it may be worth getting checked out.

Now, here are the type 2 diabetes symptoms to keep on your radar:

1. You’re drinking a lot of water… and need to pee all the time.

Having too much sugar in the blood is tough on the kidneys since those organs are responsible for processing that excess glucose, according to the Mayo Clinic. As a result, they work overtime to eliminate it from the body. As your body loses fluids, you may feel the signs of dehydration creeping in. So, you drink more fluids to make up for it, and the cycle of constantly peeing continues. That’s why frequent urination and increased thirst tend to be the two most common type 2 diabetes symptoms, particularly in the early stages.

2. And you need to pee, like, right now.

Despite peeing more often, you may also experience the strong need to go but very little—if any—comes out when you do, which is known as urgency incontinence, per the NIDDK. Although this is also a big head’s up that you might have a urinary tract infection, especially for people with vaginas, it’s also common with type 2 diabetes.

3. Your mouth feels super dry.

As we mentioned, when you pee more often your chances of getting dehydrated go up, which will often kick-start your thirst response. With type 2 diabetes, the excess glucose in your system also takes fluid out of your tissues, making that thirst more ferocious. That can be exacerbated by having a dry mouth and the feeling that you simply can’t drink enough water or other fluids to switch off that thirsty feeling.

Dry mouth is characterized by feeling a lack of saliva often or most of the time; a dry, rough tongue; pain in the mouth; cracked lips; mouth sores or infections; and problems with chewing, swallowing, or even talking, per the NIDDK. Because of this, dry mouth can raise your risk for certain dental problems, like tooth decay and gum disease.

4. You have weird changes in your vision.

People with diabetes can also develop diabetic retinopathy, which is a condition that can cause damage to the retina (the thin, light-sensitive tissue that lines the inside surface of the back of your eyes) over time, according to the American Optometric Association. That’s because excess blood glucose damages all of the tiny blood vessels in your body, including those in your eyes. This is a problem because the eyes’ blood vessels will then break and leak fluids, resulting in complications like cloudy or blurry vision or difficulty focusing.

If type 2 diabetes goes untreated, new blood vessels may form in your retina as a response—but because they’re so fresh, they’re more prone to leaking as well, causing the eye tissue to swell. Over time, if type 2 diabetes continues to go untreated, your risk of vision loss goes up.

5. You can’t satisfy your hunger.

Even if you have a big meal, you might walk away feeling hungry, the Mayo Clinic says. That’s because insulin resistance is preventing glucose from reaching your cells to give you the much-needed energy boost that food provides—so your brain and muscles keep sending hunger signals as a result.

6. You feel tired (and cranky!) all the time.

The blood sugar spike you experience after eating can cause major fatigue because the glucose isn’t being processed effectively in your body. Dehydration can also make you feel tired, the Mayo Clinic says, and so can trouble sleeping if your symptoms (like dry mouth or constantly needing to pee) are causing discomfort.

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