Diabetes

1 What is Diabetes?

Diabetes mellitus is a group of diseases in which the metabolism of blood sugar (glucose) is affected. Glucose is the most important source of energy for the cells of the body especially the brain cells. People with diabetes have high blood sugar and this can lead to serious complications, if left untreated.

Types of diabetes include type 1 and type 2 diabetes, prediabetes and gestational diabetes. Type 1 and type 2 diabetes are chronic conditions while prediabetes and gestational diabetes can be reversed. Prediabetes is a condition in which a person has high blood sugar but not high enough to be classified as diabetes. Gestational diabetes occurs during pregnancy and tends to disappear after delivery.

diabetes

2 Symptoms

The symptoms of diabetes vary depending on the level of blood sugar.

The symptoms of type 1 diabetes usually appear quickily as compared to the other types of diabetes. Patients with type 1 diabetes may also experience more severe symptoms. Type 1 diabetes tends to develop during childhood and adolescence while type 2 diabetes mostly occurs in adults over the age of 40.

Some of the signs and symptoms of type 1 and type 2 diabetes include:

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3 Causes

Causes of Diabetes may vary depending on its type.

To understand diabetes, it is important to understand how glucose is normally processed in the body.

The pancreas produces and secretes insulin, a hormone, into the bloodstream. The insulin circulates, enabling sugar to enter the cells. Insulin lowers the amount of sugar in the bloodstream. As blood sugar level drops, so does the secretion of insulin from the pancreas.

Glucose (sugar) is a source of energy for the cells that make up muscles and other tissues. Glucose comes from two major sources: food and the liver. Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin. The liver stores and makes glucose. When blood glucose levels are low, such as when a person hasn't eaten in a while, the liver breaks down stored glycogen into glucose to keep the glucose level within a normal range.

The exact cause of type 1 diabetes is unknown. What is known is that the immune system — which normally fights harmful bacteria or viruses — attacks and destroys the insulin-producing cells in the pancreas. This leaves a person with little or no insulin. Instead of being transported into the cells, sugar builds up in the bloodstream. Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what many of those factors are is still unclear.

Causes of prediabetes and type 2 diabetes

In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, the cells become resistant to the action of insulin, and the pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into the cells where it's needed for energy, sugar builds up in the 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.

During pregnancy, the placenta produces hormones to sustain pregnancy. These hormones make the cells more resistant to insulin. Normally, the pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes the pancreas can't keep up. When this happens, too little glucose gets into the cells and too much stays in the blood, resulting in gestational diabetes.

4 Making a Diagnosis

The following tests can be used for the diagnosis of type 1 and type 2 diabetes:

  • Glycated hemoglobin (A1C) test - which can indicate the amount of sugar in the blood for the past two to three months. This tests works by measuring the amount of glucose attached to hemoglobin, the oxygen carrying protein of red blood cells. An A1C level of 6.5 percent or higher indicates diabetes.
  • Fasting blood sugar test - in which a person is asked to fast overnight and the level of sugar is measured on the next day, usually in the morning. A fasting blood sugar level of 100 mg/dL (5.6 mmole/L) is normal. A fasting blood sugar level of 100-125 mg/dL (5.6- 6.9 mmol/L) is considered as prediabetes and if it is higher than 126 mg/dL (7mmol/L) it is considered as diabetes.
  • Random blood sugar test - which can be taken at any time. Regardless of when the patient last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) indicates diabetes.
  • Oral glucose tolerence test - A patient is asked to fast overnight and the fasting blood sugar level is measured. Then he or she is asked to take a sugary liquid and the blood sugar level is measured two hours later. A blood sugar level of less than 140 mg/dL (7.8mmol/L) is normal. A reading of 140 to 199 mg/dL (7.8-11.0 mmol/L) indicates prediabetes and a reading of more than 200 mg/dL (11.1 mmol/L) indicates diabetes.

Urinalysis can be performed for people with type 1 diabetes to check for the presence of ketones-byproducts produced when muscle and fat tissue are used for energy when the body doesn't have enough insulin to use the available glucose. 

Tests that can be used in routine screening for gestational diabetes include:

  • Initial glucose challenge test - in which a women is asked to drink a syrupy sugar solution and the blood sugar is measured an hour later. A blood sugar level below 130 to 140 mg/dL ( 7.2 to 7.8 mmol/L) is considered as a normal glucose challenge test. If it is higher it indicates that a woman has an increased risk of developing gestational diabetes.
  • Follow-up glucose tolerance test - in which a pregnant women is asked to fast overnight and the blood sugar level is measured on the next day. Before the blood sugar level is measure, the woman would be asked to drink a sweet solution and then the blood sugar level is measured every three hours.
    If at least two of the results indicate high blood sugar, then a woman will be diagnosed with gestational diabetes. Frequent tests are required through out pregnancy to monitor the blood sugar level. After delivery, the blood sugar level should also be monitored to ensure the woman doesn't have type 2 diabetes.

5 Treatment

Several treament for type 1 diabetes are available.

They include:

  • Insulin Therapy which is required for lifelong treament. Types of insulin include, rapid-acting, long-acting and intermediate acting insulin.Examples are regular insulin (Humulin 70/30, Novolin 70/30), insulin isophane (Humulin N, Novolin N) insulin glulisine (Apidra), insulin lispro (Humalog) and insulin aspart (Novolog). Long-acting insulins include glargine (Lantus) and determir (Levemir). Because insulin is degraded by enzymes of the stomach, it should not be taken orally. It can be given through injections or an insulin pump. A fine needle or an insulin pen , which looks similar to ink pens can be used to inject insulin under the skin. Multiple daily injections usually consist of different types of insulin (Long-acting and regular insulin). An insulin pump is a small device about the size of a cellphone that can be worn outside the body. A tube connects the reservoir to a catheter that is inserted under the skin of the abdomen. It can be worn as a waistband, in a pocket or as a specially designed pump belt. Pumps are programmed to dispense specific amounts of rapid-acting insulin automatically. This steady dose of insulin is known as the basal rate, and it replaces any long-acting insulin that a person was using.
  • Medications that stimulate the pancreas to secrete insulin. Other medications include those that inhibit the production and release of glucose from the liver.
  • Medications such as metformin (Fortamet, Glucophage, Glumatza) which reduces the amount of sugar the liver releases into the blood. Side effects of this drug include nausea, stomach upset, diarrhea and headaches.
  • Medications, such as high blood pressure medications, drugs like pramlintide which reduce the rate of movement of food through the stomach to reduce the sharp rise in blood sugar that occurs after meals, Aspirin to protect the heart and cholesterol-lowering drugs.
  • Artificial pancreas is an emerging treatment approach in which patients with type 1 diabetes are given a closed-loop insulin delivery. The device automatically delivers the correct amount of insulin when a monitor indicates the need for it.There are a number of different versions of the artificial pancreas, and clinical trials have had encouraging results.
  • Gastric bypass surgery to help people with type 2 diabetes to lose weight
  • Healthy eating and monitoring carbohydrates.
  • Regular exercising, at least 30 minutes of aerobic exercise on most days of the week.

Treatment strategies for gestational diabetes include:

  • Monitoring blood sugar at least five to six times a day.
  • Maintaining a healthy diet and avoiding excessive weight gain.
  • Exercising regularly.
  • Taking medications which help to normalize the amount of sugar in blood.
  • Close monitoring of the baby's growth and development to prevent complications from developing.

Prediabetes can be treated by maintaining a healthy lifestyle through exercising and eating healthy. Sometimes medications such as metformin (Glucophage, Glumetza) can be given if a patient is at a high risk of diabetes.

6 Prevention

Prevention methods may vary depending on the type of diabetes.

There is no known prevention for type 1 diabetes. There is ongoing research on preventing further destruction of islets of the pancreas in people with newly diagnosed type 1 diabetes.

Type 2 diabetes, prediabetes and gestational diabetes can be prevented by:

  • Eating a healthy diet low in fat and calories which includes fruits, vegetables and whole grains.
  • Encouraging a child to take part in physical activities.
  • Losing excessive weight.

7 Alternative and Homeopathic Remedies

Currently, there is no approved alternative remedy for diabetes.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with diabetes.

Managing diabetes requires a lot of effort and time and this can prove to be very stressful, especially in the beginning. If it is not managed properly, it can result in changes in behaviour such as irritability.

People with diabetes are at an increased risk of having depression and diabetes-related distress. It is for this reason that many diabetic specialists regularly include a psychologist or social worker as part of their diabetic team.

Joining a support group can be very helpful for patients with diabetes. It is very important for patients with diabetes to follow round-the-clock treatment to prevent the development of serious and life threatening complications.

The following tips can be helpful:

  • Taking medications as recommended
  • Wearing a tag that shows a person has diabetes
  • Having yearly physical and regular eye exams
  • Being up to date with immunizations since diabetes can weaken the immune system
  • Paying special attention to the feet to check for sores, cracks, blisters or cuts.
  • Keeping blood pressure and blood cholesterol under control
  • Quit smoking and avoiding excessive consumption of alcohol
  • Avoiding prolonged exposure to stress, since stress can prevent insulin from functioning properly.

9 Risks and Complications

There are several risks and complications associated with diabetes.

The risk factors for developing type 1 diabetes include:

  • Family history
  • Environmental factors, such as viral illnesses.
  • Presence of auto-antibodies.
  • Early exposure to cow's milk.
  • Living in certain countries, such as Sweden and Finland.

Factors that may increase the risk of prediabetes and type 2 diabetes include:

  • Having excess weight
  • Physical inactivity
  • Family history
  • Being black, Hispanic, American Indian or Asian.
  • Being older than 40
  • A history of gestational diabetes.
  • Polycystic ovary syndrome
  • High blood pressure
  • Abnormal cholesterol and triglyceride levels

The risk factors for gestational diabetes include:

  • Being older than 25
  • Family or personal history of gestational diabetes
  • Being overweight
  • Being black, Hispanic, American Indian or Asian.

The complications of diabetes mostly occur due to poor control of blood sugar. They include:

  • Cardiovascular diseases
  • Nerve damage (neuropathy)
  • Kidney damage (nephropathy)
  • Eye damage (retinopathy)
  • Foot damage
  • Skin conditions
  • Hearing impairment
  • Alzeimer's disease

Complications of gestational diabetes include:

  • Complications that affect the baby,such as:
    • Excessive birth weight (9 pounds or more)
    • Early (preterm) birth
    • Respiratory distress syndrome-a condition which makes breathing difficult due to immatuiry of the lungs.
    • Low blood sugar (hypoglycemia) which can lead to seizures
    • Type 2 diabetes later in life.
  • Complications in the mother include:
    • High blood sugar and preeclampsia. Preeclampsia is a serious complication of pregnancy that causes high blood pressure and other symptoms that threaten the lives of both the mother and baby.
    • Increased risk of developing type 2 diabetes in the future.
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