Diabetes

What is diabetes?

Diabetes is a metabolic disease that causes High blood sugar. The human body contains Insulin – a hormone responsible for regulating the blood glucose levels and directing it for its intended use. Diabetes occurs when the body is either unable to produce enough insulin as per need, or when the body is rendered unable to use the insulin already produced. Due to this, glucose levels in the body go unchecked, which lead to a multitude of health problems over time. These include the following:

• Heart disease
• Stroke
• Kidney disease
• Eye problems
• Dental disease
• Nerve damage
• Non healing ulcers
• Gangrene of foot
• Recurrent fungal infections

There are different types of diabetes, each with their unique symptoms, causes and treatment options. While there is no complete cure for the disease as of yet, steps can be taken to manage the disease and live a relatively healthy life.

What are the different types of diabetes?

The most common types of diabetes are Type-1 and Type-2 diabetes and Gestational Diabetes. The other less common types of the disease that can occur are monogenic diabetes, maturity onset diabetes of the young and cystic-fibrosis related diabetes.

Type-1 Diabetes:

Type-1 diabetes is a chronic condition also known as insulin-dependent diabetes or juvenile-onset diabetes. It is an auto-immune disease, where the body begins attacking the pancreas with antibodies. Due to this, the cells in the pancreas responsible for producing insulin are destroyed, leading to an absence of insulin in the body. Insulin is the hormone that helps the body’s cells convert glucose into energy. As the body stops producing insulin, glucose does not pass from the bloodstream into the cells leading to a build-up of glucose in the system. This increases the level of blood sugar leading to both short-term and long-term problems. These include damage to the blood vessels in the eyes, nerves and kidneys. There is also an increased risk of heart disease and strokes.

People suffering from Type-1 diabetes can lead long and healthy lives provided they make the needed changes to their lifestyle, monitor their glucose levels regularly and carefully and abide by the treatment plan prescribed to them.

Type-2 Diabetes:

The more common type of the disease, Type-2 diabetes accounts for 95% of diabetes cases in adults across the world. This type of diabetes used to be called adult-onset diabetes, but with the rising epidemic of obesity in children, more teenagers have been found to exhibit signs of the disease. In this chronic medical condition, the body’s cells lose their ability to respond to insulin as well as they should. As a result the body isn’t able to effectively use insulin to guide glucose into the body’s cells. This causes the body to look for alternative energy sources in the tissues, muscles and organs, causing damage in the process. In this condition the body becomes resistant to insulin and stops using the hormone efficiently. This forces the pancreas to work harder to produce greater quantities of the hormone causing damage to the cells in the organ. Over time, the pancreas loses the ability to produce more insulin. Since the body is unable to respond to insulin, the level of glucose build-up surges rapidly, leaving the cells starving for energy and sugar levels at dangerously high levels.

Gestational Diabetes:

During the period of pregnancy, some are liable to develop high sugar levels. While pregnant, the mother’s body becomes naturally resistant to insulin, as greater levels of glucose get re-directed to the foetus for proper development. If the insulin resistance in the mother’s body becomes too strong, blood sugar levels shoot up and this can cause gestational diabetes. Insulin resistance is caused by the presence of hormones like human placental lactogen (hPL), which protect the placenta and help in sustaining the pregnancy. This type of diabetes generally develops between the 24th and 28th week and according to reports published by the National Health Institute and Centres for Disease Control and Prevention, it is estimated to occur in 2 to 10% of pregnancies.

Diabetes – What to look for

Diabetes is a chronic condition that affects many people all over the world. Early detection is imperative with diabetes, as its conditions only worsen over time if it remains unchecked. Diabetes symptoms are usually very mild but may occur when the blood sugar levels in the body become abnormally high. The most common symptoms of diabetes include:

• Elevated thirst
• Increased hunger
• Extreme fatigue
• Increased urination, especially at night
• Blurred vision

These symptoms can vary from one person to another and also depend on the type of diabetes one has. Symptoms of Type-1 diabetes tend to begin abruptly and dramatically and are seen most often in children, adolescents and young adults. In addition to the listed symptoms, those affected by the disease may also experience a quick and sudden loss in weight. Type-2 diabetes is more common and although it develops primarily in adults, more cases of younger people being diagnosed by it are being seen. Many people with this type of diabetes do not experience any symptoms. Many times, these symptoms are slow to manifest and develop.

Along with the symptoms listed above, people also experience certain additional symptoms on account of their gender. For men, this includes erectile dysfunction, decreased sex drive and poor muscle strength. For women, symptoms such as urinary tract infections, yeast infections and dry, itchy skin are observed.

Type – 1 Diabetes Mellitus

It is extremely crucial to detect the disease as soon as possible in order to avoid suffering the more serious effects of the disease. The common symptoms of this type of diabetes include:

• Excessive hunger
• Excessive thirst
• Blurred vision
• Fatigue
• Frequent urination
• Dramatic weight loss in a short period of time

In some cases the sugar levels in the blood rise to a very high level, causing a dangerously high build-up of an acidic substances known as ketones in the body. The resulting condition is known as Diabetic ketoacidosis (DKA), and it is a serious complication of Type-1 diabetes. Persons afflicted by this condition exhibit the following symptoms along with the others:

• Rapid breathing
• Dry skin and mouth
• Flushed face
• Fruity breath odour
• Nausea
• Vomiting or stomach pain

If a patient is experiencing the symptoms of DKA, it is extremely important to get them medical help immediately, as if left untreated, it can lead to a coma or death.

Type – 2 Diabetes Mellitus

It is crucial to keep an eye out for the symptoms of Type-2 diabetes as these can develop slowly and could be mild and easy to dismiss in the beginning. These symptoms include:

• Constant hunger
• A lack of energy
• Fatigue
• Weight loss
• Excessive thirst
• Frequent urination
• Dry mouth
• Itchy skin
• Blurry vision

But as the disease progresses, these symptoms can become more severe. Later symptoms may include:

• Yeast infections
• Slow-healing cuts or sores
• Dark patches on the skin, a condition known as acanthosis nigricans
• Foot pain
• Feelings of numbness in the extremities, or neuropathy

This type of diabetes can be managed effectively by maintaining a healthy, balanced diet, controlling body weight, exercising regularly and routinely checking the blood sugar level.

Gestational Diabetes Mellitus:

Doctors routinely scan expecting mothers for signs of gestational diabetes, and if you have no known signs of high blood sugar and no history of diabetes, the scan will occur in the 24-28th week. Gestational diabetes usually resolves itself after childbirth but could put the women at risk for developing Type-2 diabetes. It is important for the mothers to carefully follow treatment plans during this time as risks to their unborn child are greater and include abnormal weight gain before birth, breathing problems at birth, and higher obesity and diabetes risk later in life. Treatment options for this are:

This type of diabetes rarely causes symptoms, and if one experiences them, they are likely to be mild. The symptoms include:

• Fatigue
• Blurred vision
• Excessive thirst
• Excessive need to urinate

Risk factors for diabetes:

There are many factors that play a role in the manifestation and development of diabetes. These comprise a variety of environmental, lifestyle and gene-related factors and put people at greater risk of contracting the disease. With Type-1 diabetes, these risk factors are more prevalent at a younger age or it is also at risk of being inherited by parents who have diabetes. The risk factors for Type-2 diabetes on the other hand are greater in those who:

• Are overweight
• Are of age 45 or older
• Have a parent or a sibling with the condition
• Are not physically active
• Have been afflicted with gestational diabetes
• Have been diagnosed with prediabetes
• Have high blood pressure, high cholesterol, or high triglycerides

For pregnant women, the risk for gestational diabetes increases if they:

• Are overweight
• Are over the age of 25
• Have been diagnosed with gestational diabetes during a previous pregnancy
• Have given birth to a baby that weighs more than 9 pounds
• Have a family history of type 2 diabetes
• Have polycystic ovary syndrome (PCOS)

Management of diabetes is through:

1. Timely monitoring of body weight, Blood sugar levels

2. Adoption of healthier lifestyle through modification of habits

    a. Giving up of smoking and minimizing alcohol intake

    b. Regular exercise

    c. Eating right

3. Medications:

    a. Insulin is the treatment of choice in type-1 diabetes as the body doesn’t produce insulin.

    b. In type 2 diabetes initially oral medications are given which facilitate production of more insulin or their entry into cells, or excretion of blood glucose through urine. However with progression of disease or in complications insulin is given.

* * The choice of treatment in a diabetic depends on the type of diabetes, age of the individual, duration of diabetes, and presence of complications. The decision of the modality of treatment lies entirely with the diabetologist.

Special Consideration for Gestational Diabetes:

• Careful planning of meals to guarantee adequate pregnancy nutrients without excess fat and calories.
• Exercising every day.
• Controlling weight gain during pregnancy.
• Taking insulin to control blood sugar levels if needed.

Diabetes can be managed effectively by maintaining a healthy, balanced diet, controlling body weight, exercising regularly and routinely checking the blood sugar level.

Disclaimer : The details provided herein is meant for informative purposes only. For detailed information related to the disease and its treatment please consult a relevant qualified specialist.

Understanding blood sugar:

Glucose is a fundamental source of energy in the human body. It is produced in the body in low levels, but is majorly sourced from the food consumed. Its importance stems from its ability to convert into energy, needed in constant supply by the brain and nerves in the body. The blood glucose level is the level of sugar present in the bloodstream. Insulin is the hormone secreted by the pancreas and crucial for its ability to guide the glucose into its energy conversion cycle. Understanding blood glucose/sugar levels is a crucial step in self-management of diabetes.

Normal blood sugar levels in the body range between less than 100 mg/dL and 140 mg/dL. The lower range presents itself when the body has been fasting or not eating for at least 8 hours. The higher range presents itself 2 hours post consumption of food. The regular sugar levels in the body before food consumption usually lies between 70-80 mg/dL. For people unaffected by diabetes, the blood sugar level does not fall below 60 mg/dL, even with prolonged fasting. This is because the liver keeps these levels at a normal range by converting fat and muscle into energy. Any higher sugar level is a sign for trouble, some of which include:

• The presence of high sugar levels in the blood corrodes the pancreatic cells ability to create insulin over time. Because of this, the pancreas overworks to try and to regain balance. Over time, the organ gets completely. ??Seems incomplete ?
• Presence of high sugar levels in the blood can cause hardening of blood vessels over time, causing changes in blood vessels of heart leading to heart attack.
• Constantly raised blood sugar cause changes in small blood vessels of kidney, eyes leading to chronic diabetic kidney and eye diseases.
• Nerve damage causing diabetic neuropathy

The blood sugar level that diabetic patients ideally should exhibit:

If diabetics must fast or exercise they should closely monitor their blood sugar levels before doing so to prevent episodes of very low blood sugar level which may lead to dizziness, unconsciousness or fits.

How and when to test blood sugar:

For a person afflicted with diabetes, understanding blood sugar and when and how it needs to be tested is of prime importance. With advancements in medical technology, it now easy to check these levels anytime and anywhere with help of an electronic portable glucose meter. Blood sugar testing, or self-monitoring of blood glucose levels is crucial as it can help you:

• Understand whether you are achieving the comprehensive treatment objectives
• Gain knowledge on how maintaining a healthy diet and regular exercise affect blood sugar levels.
• Find out how different ailments and other factors like stress affect the sugar levels in the blood.
• Regularly observe and record the effect of medications on the sugar levels in the blood.
• Understand when the sugar levels in the blood are high or low.

Depending on the type of diabetes and the treatment plan prescribed, the frequency at which this needs to be checked is usually as follows:

Type-1 Diabetes:

For patients with Type-1 diabetes, doctors recommend testing the sugar levels in the blood 4 to 10 times a day (citations). The testing should be done before eating meals, pre and post exercising, before sleeping and sometimes during the night. When ill, starting new medication or making changes in the daily routine the testing should be done more frequently.

Type-2 Diabetes:

Since taking insulin regularly is not recommended for everyone with Type-2 diabetes, testing should be done less frequently. If the individual is prescribed insulin in type 2 diabetes, then the same approach of monitoring blood sugar as in type 1 diabetes can be adopted. And if the individual is managing their diabetes with regular diet and exercise alone, they may not require daily testing.

Taking charge:

While there is no absolute cure for diabetes as of yet, it can be managed effectively to live a long and healthy life. The patient needs to focus on setting definitive goals so they can manage their condition efficiently. Some of these goals are:

• Set clearly defined goals: Decide on certain objectives and map out a plan to achieve them. It is advisable to starts with steps that are measureable and realistic. For example, start with 30 minutes of exercise each day and slowly increase the duration over time.
• Learn more about diabetes: It is important to get more information on the disease, since this condition is for the long term. Knowledge on diabetes can be found in medical reports, texts and articles available both online and offline.
• Take care: Make sure all check-ups and tests are done regularly, along with maintaining a healthy diet and carrying out physical exercise.
• Seek support: Since diabetes lasts for a long time, patients have been observed to feel fatigued and disheartened. It is important for the patient to surround themselves with a group of to support them and motivate them through this journey.
• Keep regular records: It is crucial to keep a record of blood glucose levels, medications, side-effects experienced and other factors that can help you and your healthcare provider better plan out treatment options.
• Use reminders: Since it is important to check blood sugar levels at regular intervals, the blood glucose monitor should always be kept close at hand. Regular reminders should be maintained to remind the patients to take medicines and check their blood.
• Stay motivated: The lifestyle changes that a patient needs to make can be disconcerting, but they should remind themselves of the benefits that they gain from it. Keeping a positive attitude helps greatly and this can be done by recognising and appreciating the efforts made towards the goal of healthy living.