Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic disorders in which there are high blood glucose (blood sugar) levels over a prolonged period, either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. It is a chronic, often debilitating and sometimes fatal disease.
Patients with high blood sugar will typically experience frequent urination (polyuria), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).
The term diabetes comes from Greek, and it means "siphon". Aretus the Cappadocian, a Greek physician during the second century A.D., described patients who were passing too much water as a siphon.
In 1675, Thomas Willis added mellitus to the term. Mel in Latin means "honey"; the urine and blood of people with diabetes has excess glucose, and glucose is likened to honey in taste. Diabetes mellitus could literally mean "siphoning off sweet water".
In ancient China people observed that ants would be attracted to some people's urine, because it was sweet. The term "Sweet Urine Disease" was coined.
Many more people have blood sugar levels above the normal range, but not high enough to be diagnosed as having diabetes.
This is sometimes known as prediabetes. If your blood sugar level is above the normal range, your risk of developing full-blown diabetes is increased.
The vast majority of patients with type 2 diabetes initially had prediabetes. Studies have indicated that even at the prediabetes stage, some damage to the circulatory system and the heart may already have occurred.
It's very important for diabetes to be diagnosed as early as possible because it will get progressively worse if left untreated.
Understanding the Cause of Diabetes
Diabetes mellitus is classed as a metabolism disorder. Metabolism refers to the way our bodies use digested food for energy and growth. Most of what we eat is broken down into glucose. Glucose is a form of sugar in the blood; it is the principal source of fuel for our bodies.
When our food is digested, the glucose makes its way into our bloodstream. Our cells use the glucose for energy and growth. However, glucose cannot enter our cells without insulin being present; insulin makes it possible for our cells to take in the glucose.
Insulin is a hormone that is produced by the pancreas. After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, as soon as glucose enters the cells blood-glucose levels drop.
A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated (hyperglycemia). This is because the body does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces. This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements.
Types Types of diabetes include:
Type 1 diabetes
Type 1 diabetes occurs because the insulin-producing cells of the pancreas (called beta cells) are destroyed by the immune system. The body does not produce insulin. Some people may refer to this type as insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes.
People usually develop type 1 diabetes before their 40th year, often in early adulthood or teenage years, although it can appear at any age.
Type 1 diabetes is nowhere near as common as type 2 diabetes. Approximately 10% of all diabetes cases are type 1.
Patients with type 1 diabetes will need to take insulin injections for the rest of their lives.
Type 2 diabetes
Unlike people with type 1 diabetes, people with type 2 diabetes produce insulin. However, the insulin their pancreas secretes is either not enough or the body is unable to recognize the insulin and use it properly, which simply means the body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance).
This type of diabetes occurs most often in middle-aged and older people. Type 2 is the most common type of diabetes, accounting for 85 to 90% of all cases of diabetes worldwide.
Some people may be able to control their type 2 diabetes symptoms by losing weight, following a healthy diet, doing plenty of exercise, and monitoring their blood glucose levels. However, type 2 diabetes is typically a progressive disease, which gradually gets worse, and the patient will probably end up having to take insulin, usually in tablet form.
Gestational diabetes is triggered by pregnancy. Hormone changes during pregnancy in women can affect levels of glucose in their blood, and their bodies may unable to produce enough insulin to transport all of the glucose into their cells, resulting in progressively rising levels of glucose. The condition occurs in approximately 4% of all pregnancies.
The majority of gestational diabetes patients can control their diabetes with exercise and diet. Between 10% to 20% of them will need to take some kind of blood-glucose-controlling medications. Usually, blood glucose levels return to normal within six weeks of childbirth. However, women who have had gestational diabetes have an increased risk of developing type 2 diabetes later in life.
Other forms of diabetes
A few rare kinds of diabetes can result from specific conditions. For example, genetic mutations, damage to the pancreas, certain surgeries and medications, or infections can cause diabetes. These types of diabetes account for only 1% to 5% of all cases of diabetes.
Risk factors for diabetes depend on the type of diabetes.
Risk factors for type 1 diabetes
Factors that may signal an increased risk for type 1 diabetes include:
Family history. Your risk increases if a parent or sibling has type 1 diabetes.
Environmental factors. Circumstances such as exposure to a viral illness likely play some role in type 1 diabetes.
The presence of damaging immune system cells (auto-antibodies). Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes auto-antibodies. If you have these auto-antibodies, you have an increased risk of developing type 1 diabetes. But not everyone who has these auto-antibodies develops diabetes.
Geography. Certain countries, such as Finland and Sweden, have higher rates of type 1 diabetes.
Risk factors for prediabetes and type 2 diabetes
These factors below increase the risk of prediabetes and type 2 diabetes:
Weight. The more fatty tissue you have, the more resistant your cells become to insulin.
Inactivity. The less active you are, the greater your risk. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
Family history. Your risk increases if a parent or sibling has type 2 diabetes.
Race. Although it's unclear why, people of certain races; including blacks, Hispanics, American Indians and Asian-Americans are at higher risk.
Age. Your risk increases as you get older. This may be because you tend to exercise less, lose muscle mass and gain weight as you age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults.
Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing prediabetes and type 2 diabetes later increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you're also at risk of type 2 diabetes.
Polycystic ovary syndrome. For women, having polycystic ovary syndrome - a common condition characterized by irregular menstrual periods, excess hair growth and obesity - increases the risk of diabetes.
High blood pressure. Having blood pressure over 140/90 millimetres of mercury (mm Hg) is linked to an increased risk of type 2 diabetes.
Abnormal cholesterol and triglyceride levels. If you have low levels of high-density lipoprotein (HDL), or "good," cholesterol, your risk of type 2 diabetes is higher. Triglycerides are another type of fat carried in the blood. People with high levels of triglycerides have an increased risk of type 2 diabetes. Your doctor can let you know what your cholesterol and triglyceride levels are.
Low testosterone levels in men. Men whose testosterone levels are low have been found to have a higher risk of developing type 2 diabetes.
Risk factors for gestational diabetes
Any pregnant woman can develop gestational diabetes, but some women are at greater risk than are others. Risk factors for gestational diabetes include:
Age. Women older than age 25 are at increased risk.
Family or personal history. Your risk increases if you have prediabetes (a precursor to type 2 diabetes) or if a close family member, such as a parent or sibling, has type 2 diabetes. You're also at greater risk if you had gestational diabetes during a previous pregnancy, if you delivered a very large baby or if you had an unexplained stillbirth.
Weight. Being overweight before pregnancy increases your risk.
Race. For reasons that aren't clear, women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes.
Symptoms of Diabetes
The symptoms of type 1 diabetes often occur suddenly and can be severe. They include:
Increased hunger (especially after eating).
Unexplained weight loss (even though you are eating and feel hungry).
Fatigue (weak, tired feeling).
Laboured, heavy breathing (Kussmaul respirations).
Loss of consciousness (rare).
The symptoms of type 2 diabetes may be the same as those listed above. Most often, there are no symptoms or a very gradual development of the above symptoms. Other symptoms may include:
Slow-healing sores or cuts.
Itching of the skin (usually in the vaginal or groin area).
Recent weight gain.
Numbness or tingling of the hands and feet.
Impotence or erectile dysfunction.
Below is a list of possible complications that can be caused by badly controlled or undiagnosed diabetes:
Eye complications - glaucoma, cataracts, diabetic retinopathy, and some others.
Foot complications - neuropathy, ulcers, and sometimes gangrene which may require that the foot be amputated.
Skin complications - people with diabetes are more susceptible to skin infections and skin disorders.
Heart problems - such as ischemic heart disease, when the blood supply to the heart muscle is diminished.
Hypertension - common in people with diabetes, which can raise the risk of kidney disease, eye problems, heart attack and stroke.
Mental health - uncontrolled diabetes raises the risk of suffering from depression, anxiety and some other mental disorders.
Hearing loss - diabetes patients have a higher risk of developing hearing problems.
Gum disease - there is a much higher prevalence of gum disease among diabetes patients.
Gastroparesis - the muscles of the stomach stop working properly.
Ketoacidosis - a combination of ketosis and acidosis; accumulation of ketone bodies and acidity in the blood.
Neuropathy - diabetic neuropathy is a type of nerve damage which can lead to several different problems.
HHNS (Hyperosmolar Hyperglycemic Nonketotic Syndrome) - blood glucose levels shoot up too high, and there are no ketones present in the blood or urine. It is an emergency condition.
Nephropathy - uncontrolled blood pressure can lead to kidney disease.
PAD (peripheral arterial disease) - symptoms may include pain in the leg, tingling and sometimes problems walking properly.
Stroke - if blood pressure, cholesterol levels, and blood glucose levels are not controlled, the risk of stroke increases significantly.
Erectile dysfunction - male impotence.
Infections - people with badly controlled diabetes are much more susceptible to infections.
Healing of wounds - cuts and lesions take much longer to heal.
It is possible to have diabetes with only very mild symptoms or without developing any symptoms at all. Such cases can leave some people with diabetes unaware of the condition and undiagnosed. This happens in around half of people with type 2 diabetes.
Prediabetes that often leads to type 2 diabetes also produces no symptoms. Type 2 diabetes and its symptoms develop slowly.
Type 1 diabetes can go unnoticed but is less likely to do so. Some of its symptoms listed above can come on abruptly and be accompanied by nausea, vomiting or stomach pains.
It is important to see a doctor if there is any suspicion of diabetes or if any of the above signs and symptoms is present. Prompt diagnosis and management lowers the likelihood of serious complications.
Diabetes can often be detected by carrying out a urine test, which finds out whether excess glucose is present. This is normally backed up by a blood test, which measures blood glucose levels and can confirm if the cause of your symptoms is diabetes.
Doctors can determine whether a patient has a normal metabolism, prediabetes or diabetes in one of three different ways - there are three possible tests:
The A1C test - at least 6.5% means diabetes - between 5.7% and 5.99% means prediabetes - less than 5.7% means normal
The FPG (fasting plasma glucose) test - at least 126 mg/dl means diabetes - between 100 mg/dl and 125.99 mg/dl means prediabetes - less than 100 mg/dl means normal An abnormal reading following the FPG means the patient has impaired fasting glucose (IFG)
The OGTT (oral glucose tolerance test) - at least 200 mg/dl means diabetes - between 140 and 199.9 mg/dl means prediabetes - less than 140 mg/dl means normal An abnormal reading following the OGTT means the patient has impaired glucose tolerance (IGT)
At the present time, diabetes can't be cured, but it can be treated and controlled. Diabetes is a serious disease. Following your diabetes treatment plan takes round-the-clock commitment. Careful management of diabetes can reduce your risk of serious and even life threatening complications.
All types of diabetes are treatable. Diabetes type 1 lasts a lifetime, there is no known cure. Type 2 usually lasts a lifetime; however, some people have managed to get rid of their symptoms without medication, through a combination of exercise, diet and body weight control.
Patients with type 1 are treated with regular insulin injections, as well as a special diet and exercise.
Patients with Type 2 diabetes are usually treated with tablets, exercise and a special diet, but sometimes insulin injections are also required.
If diabetes is not adequately controlled or managed, the patient has a significantly higher risk of developing complications.
What lifestyle changes can help manage diabetes?
The goals of managing diabetes are to:
Keep your blood glucose levels as near to normal as possible by balancing food intake with medication and activity.
Maintain your blood cholesterol and triglyceride (lipid) levels as near their normal ranges as possible by decreasing the total amount of fat to 30% or less of your total daily calories and by reducing saturated fat and cholesterol.
Control your blood pressure. Your blood pressure should not go over 130/80.
Slow or possibly prevent the development of diabetes-related health problems.
You hold the key to managing your diabetes by adopting these lifestyle changes:
Planning what you eat and following a balanced meal plan
Adopting good sleep habits
Taking medicine, if prescribed, and closely following the guidelines on how and when to take it
Monitoring your blood glucose and blood pressure levels at home
Pay attention to your feet
Take care of your teeth
If you smoke or use other types of tobacco, ask your doctor to help you quit
If you drink alcohol, do so responsibly. Remember to include the carbohydrates from any alcohol you drink in your daily carbohydrate count. And check your blood sugar levels before going to bed.
Keeping your appointments with your health care providers and having laboratory tests as ordered by your doctor
Note: What you do at home every day affects your blood glucose more than what your doctor can do every few months during your checkups.
Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 diabetes.
Weight loss surgery
After weight loss surgery, many people with type 2 diabetes see their blood sugar levels return to near normal. Some experts call this a remission. It's not unusual for people to no longer need diabetes medicines after weight loss surgery.
The more weight a person loses after surgery, the greater improvement in blood sugar control.
After surgery, if extra weight returns, your diabetes can return too.
Reaching and keeping a healthy weight are very important for managing diabetes.
Are stem cells a possible cure for diabetes?
They hold promise, but they're not a treatment now.
Stem cells are cells that can develop into other types of cells. Scientists have had some success with stem cells in type 1 diabetes.
What about islet cell transplantation as a cure for diabetes?
A successful islet cell transplant can improve the quality of life for a person with diabetes. It's an evolving technology that's still being researched.
Islet cells sense blood sugar levels and make insulin. The cells come from a donor.
Once transplanted successfully, the donor cells begin to make and release insulin in response to blood sugar levels. This procedure can provide more flexibility with meal planning and help protect against serious long-term diabetes complications such as heart disease, stroke, kidney disease, and nerve and eye damage.
The person receiving the transplant must take medicine for the rest of their life to prevent their body from rejecting the donor's cells.
How about pancreas transplantation?
Getting a transplanted pancreas is a possibility for some people with type 1 diabetes. It's usually done in those who also have end-stage kidney (renal) disease.
A pancreatic transplant would help restore blood sugar control. Like anyone else who gets a transplant, the patient would need to take medicine for the rest of their life to help their body accept their new pancreas.
Coping and support
Living with diabetes can be difficult and frustrating. Sometimes, even when you've done everything right, your blood sugar levels may rise. But stick with your diabetes management plan, and you'll likely see a positive difference in your A1C when you visit your doctor.
Because good diabetes management can be time-consuming, and sometimes overwhelming, some people find it helps to talk to someone. Your doctor can probably recommend a mental health professional for you to speak with, or you may want to try a support group. Sharing your frustrations and your triumphs with people who understand what you're going through can be very helpful. And you may find that others have great tips to share about diabetes management.
Diabetes is a lifelong disease. As yet, there is no cure. People with diabetes need to manage their disease to stay healthy.
There is no known preventive measure for type 1 diabetes. Type 2 diabetes can often be prevented or delayed by:
Maintaining a normal body weight
Engaging in physical activity
Consuming a healthy diet. Diets known to be effective in helping to prevent type 2 diabetes include maintaining a diet rich in whole grains and fibre, and choosing good fats, such as the polyunsaturated fats found in nuts, vegetable oils, and fish. Limiting sugary beverages and eating less red meat and other sources of saturated fat can also help.
Tobacco smoking is also associated with an increased risk of diabetes and its complications, so smoking cessation can be an important preventive measure as well.
....making effort to "STAY WELL"
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