Diabetes - basics

What is Diabetes?

Diabetes is a condition in which body can’t produce enough insulin to process the glucose in the blood or group of metabolic diseases in which a person has high blood sugar. The normal process of how the body turns food into energy and the changes that occur when diabetes is present, is explained below.

• Food is changed in to glucose : The stomach changes the food we eat into a fuel called glucose, a form of sugar. Glucose goes into the blood stream and is carried to the millions of cells in the body.
• Glucose gets into the cells : An organ called the pancreas makes a chemical called insulin. Insulin also goes into the bloodstream and travels to the cells. It meets glucose and enables it to enter the cells.
• Cells turn glucose into energy : The cells metabolize (burn) the glucose to give the body energy.

When diabetes is present, the changes that happen are

• Diabetes makes it harder for the body to get energy from food.
• Food is changed into glucose : The stomach still changes the food we eat into glucose. Glucose goes into the bloodstream. But most of the glucose may not be able to enter the cells because:

1. There may not be enough insulin.
2. There may be plenty of insulin, but it can’t unlock the receptors.
3. There may be too few receptors for all the glucose to get through.

• Cells can’t make energy : Most of the glucose stays in the bloodstream. This is called hyperglycemia (also known as high blood glucose or high blood sugar). Without enough glucose in the  cells, the cells can’t make the energy needed to keep the body running smoothly.

Types of diabetes

There are three main types of diabetes:

Type 1 diabetes used to be called juvenile-onset diabetes. It is usually caused by an auto-immune reaction where the body’s defence system attacks the cells that produce insulin. The reason this occurs is not fully understood. People with type 1 diabetes produce very little or no insulin. The disease may affect people of any age, but usually develops in children or young adults. People with this form of diabetes need injections of insulin every day in order to control the levels of glucose in their blood. If people with type 1 diabetes do not have access to insulin, they will die.

Type 2 diabetes used to be called non-insulin dependent diabetes or adult-onset diabetes, and accounts for at least 90% of all cases of diabetes. It is characterised by insulin resistance and relative insulin deficiency, either or both of which may be present at the time diabetes is diagnosed. The diagnosis of type 2 diabetes can occur at any age. Type 2 diabetes may remain undetected for many years and the diagnosis is often made when a complication appears or a routine blood or urine glucose test is done. It is often, but not always, associated with overweight or obesity, which itself can cause insulin resistance and lead to high blood glucose levels. People with type 2 diabetes can often initially manage their condition through exercise and diet. However, over time most people will require oral drugs and or insulin.

Both type 1 and type 2 diabetes are serious. There is no such thing as mild diabetes.

Gestational diabetes (GDM) is a form of diabetes consisting of high blood glucose levels during pregnancy. It develops in one in 25 pregnancies worldwide and is associated with complications to both mother and baby. GDM usually disappears after pregnancy but women with GDM and their children are at an increased risk of developing type 2 diabetes later in life. Approximately half of women with a history of GDM go on to develop type 2 diabetes within five to ten years after delivery.

Other specific types of diabetes also exist.

Complications of Diabetes

People with diabetes have an increased risk of developing a number of serious health problems. Consistently high blood glucose levels can lead to serious diseases affecting the heart and blood vessels, eyes, kidneys, nerves and teeth. In addition, people with diabetes also have a higher risk of developing infections. In almost all high-income countries, diabetes is a leading cause of cardiovascular disease, blindness, kidney failure, and lower limb amputation.

Maintaining blood glucose levels, blood pressure, and cholesterol at or close to normal can help delay or prevent diabetes complications. Therefore people with diabetes need regular monitoring.

Cardiovascular disease: affects the heart and blood vessels and may cause fatal complications such as coronary artery disease (leading to heart attack) and stroke. Cardiovascular disease is the most common cause of death in people with diabetes. High blood pressure, high cholesterol, high blood glucose and other risk factors contribute to increasing the risk of cardiovascular complications.

Kidney disease (diabetic nephropathy): caused by damage to small blood vessels in the kidneys leading to the kidneys becoming less efficient or to fail altogether. Kidney disease is much more common in people with diabetes than in those without diabetes. Maintaining near normal levels of blood glucose and blood pressure can greatly reduce the risk of kidney disease.

Nerve disease (diabetic neuropathy): diabetes can cause damage to the nerves throughout the body when blood glucose and blood pressure are too high. This can lead to problems with digestion, erectile dysfunction, and many other functions. Among the most commonly affected areas are the extremities, in particular the feet. Nerve damage in these areas is called peripheral neuropathy, and can lead to pain, tingling, and loss of feeling. Loss of feeling is particularly important because it can allow injuries to go unnoticed, leading to serious infections and possible amputations. People with diabetes carry a risk of amputation that may be more than 25 times greater than that of people without diabetes. However, with comprehensive management, a large proportion of amputations related to diabetes can be prevented. Even when amputation takes place, the remaining leg and the person’s life can be saved by good follow-up care from a multidisciplinary foot team. People with diabetes should regularly examine their feet.

Eye disease (diabetic retinopathy): most people with diabetes will develop some form of eye disease (retinopathy) causing reduced vision or blindness. Consistently high levels of blood glucose, together with high blood pressure and high cholesterol, are the main causes of retinopathy. It can be managed through regular eye checks and keeping glucose and lipid levels at or close to normal.

Pregnancy complications: Women with any type of diabetes during pregnancy risk a number of complications if they do not carefully monitor and manage their condition. To prevent possible organ damage to the fetus, women with type 1 diabetes or type 2 diabetes should achieve target glucose levels before conception. All women with diabetes during pregnancy, type 1, type 2 or gestational should strive for target blood glucose levels throughout to minimize complications. High blood glucose during pregnancy can lead to the foetus putting on excess weight. This can lead to problems in delivery, trauma to the child and mother, and a sudden drop in blood glucose for the child after birth. Children who are exposed for a long time to high blood glucose in the womb are at higher risk of developing diabetes in the future.

Risk factors

The risk factors for type 1 diabetes are still being researched. However, having a family member with type 1 diabetes slightly increases the risk of developing the disease. Environmental factors and exposure to some viral infections have also been linked to the risk of developing type 1 diabetes.

Several risk factors have been associated with type 2 diabetes and include:

• Family history of diabetes
• Overweight
• Unhealthy diet
• Physical inactivity
• Increasing age
• High blood pressure
• Ethnicity
• Impaired Glucose Tolerance (IGT)*
• History of gestational diabetes
• Poor nutrition during pregnancy

Impaired Glucose Tolerance (IGT) is a category of higher than normal blood glucose, but below the threshold for diagnosing diabetes.

Changes in diet and physical activity related to rapid development and urbanisation have led to sharp increases in the numbers of people developing diabetes.

Pregnant women who are overweight, have been diagnosed with Impaired Glucose Tolerance (IGT), or have a family history of diabetes are all at increased risk of developing Gestational diabetes (GDM). In addition, having been previously diagnosed with gestational diabetes or being of certain ethnic groups puts women at increased risk of developing GDM.

Signs & symptoms of diabetes

Individuals can experience different signs and symptoms of diabetes, and sometimes there may be no signs.

Some of the signs commonly experienced include:

1. Frequent urination
2. Excessive thirst
3. Increased hunger
4. Weight loss
5. Tiredness
6. Lack of interest and concentration
7. A tingling sensation or numbness in the hands or feet
8. Blurred vision
9. Frequent infections
10. Slow-healing wounds
11. Vomiting and stomach pain (often mistaken as the fever related)

The development of type 1 diabetes is usually sudden and dramatic while the symptoms can often be mild or absent in people with type 2 diabetes, making this type of diabetes hard to detect.

Blood tests Levels for Diagnosis of Diabetes and Prediabetes.

Mg=milligram, dL=deciliter. For all three tests, within the prediabetic range, the higher the test result, the greater the risk of diabetes.

Source: Portal Content Team