The five stages of diabetes progression are compensation, stable adaptation, unstable early decompensation, stable decompensation and severe decompensation. Each stage is characterized by changes in β-cell mass, phenotype and function, states the American Diabetes Association.
Compensation occurs when an increase in β-cell mass causes an increase in insulin secretion. The increase in insulin secretion provides resistance and compensates for the increase in β-cell mass. In the second stage, β-cells are no longer compensating because normal glucose levels can no longer be maintained. This stage is considered stable because patients usually avoid progression to diabetes for years, states the American Diabetes Association.
Unstable early decompensation occurs when glucose levels begin to rise rapidly from a range of 130 milligrams per deciliter to 285 milligrams per deciliter, at which point stable decompensation begins. By the time stable decompensation begins, the patient has either reached type 1 or type 2 diabetes. This stage is considered stable because many patients with type 2 diabetes have enough insulin secretion to remain in this stage for a lifetime, but those with type 1 diabetes often progress to the fifth stage rather rapidly due to autoimmune destruction of β-cells. Severe decompensation occurs when the loss of β-cells is so massive that patients become ketotic and dependent on insulin for survival, explains the American Diabetes Association.