Diabetes is a metabolic disease that causes the amount of blood sugar (glucose) to increase beyond normal levels. Another name for this disease is diabetes mellitus. This has become one of the leading chronic diseases in modern life.
Diabetics experience a wide range of symptoms, including chronic thirst and hunger, passing increased volumes of urine, weight loss, general fatigue and blurred vision.
Although doctors can use a wide range of drugs to treat this condition, type 2 diabetes can also be effectively managed by changes in lifestyle, including dietary modifications and increasing daily exercise.
Causes & Complications
In a healthy person, the pancreas produces a hormone called insulin that removes excess sugar from the blood and stores it in cells to be used later as a source of energy. However, in diabetics, the body is either unable to produce enough insulin or cannot put the insulin it does make to effective use.
The result is excess blood sugar that can do tremendous damage to bodily tissues, including the eyes, kidneys and other organs. Diabetics can even suffer from ulcers of the feet or lose legs, arms, fingers or toes as a result of amputation. Nerve damage, such as the type that can cause sciatica, is another possible result of excess blood sugar.
High blood sugar levels can also increase the risk of other types of metabolic illness such as heart disease. By causing hardening of the arteries, diabetes can lead indirectly to high blood pressure. Together with high blood pressure and obesity, diabetes can produce a life threatening health condition known as metabolic syndrome. This, in turn, increases the risk of coronary heart disease and stroke.
Other possible complications of persistently high blood sugar are neuropathy, retinopathy, blindness, kidney disease, deafness, dermatological problems like skin infections, depression and even dementia.
Types Of Diabetes
There are 2 primary forms of diabetes – type 1 and type 2.
Type 1 Diabetes
This is an auto immune form of the disease. It causes the immune system to attack and destroy the cells of the pancreas, the organ responsible for producing insulin. This impairs the function of the pancreas and causes it to produce insufficient insulin, which then results in excess blood sugar.
Approximately 8 – 10% of patients with diabetes have this form of the disease.
Type 2 Diabetes
In people with type 2 diabetes, the pancreas produces sufficient amounts of insulin, but the body becomes resistant to the hormone and cannot use it to break down blood sugar as it needs to. This then causes sugar to build up in the blood, with the adverse consequences noted above.
Minor Forms Of The Disease
Other, less commonly encountered forms of the disease are prediabetes and gestational diabetes.
Prediabetes is a condition characterized by unusually high blood glucose levels but not levels high enough to produce the type 1 or 2 forms of the disease.
Gestational diabetes is a temporary form of the disease that appears in some women during pregnancy. It is caused by the presence of insulin blocking hormones produced by the placenta (an organ that develops in the uterus during pregnancy). The condition usually resolves after the pregnancy. However, women who have had gestational diabetes have an increased risk of developing type 2 diabetes in the future.
The risk factors that can increase the chances of developing the condition are as follows:
For the type 1 form of the disease, the main risk factors are:
Being a child or teenager (these are the ages at which most cases of type 1 tend to occur);
Having a close relative (parent or sibling) who is a type 1 diabetic;
Having a genetic profile that predisposes you to the type 1 version of the disease.
Risk factors for type 1 diabetes are not as clear as for prediabetes and type 2 diabetes.
An individual is more likely to develop the type 2 form of the condition if:
They are overweight (this is the main risk factor);
They are aged 45 or older;
They have a parent or sibling who is a type 2 diabetic;
They lead a sedentary lifestyle;
They have suffered from gestational diabetes in the past;
They have hypertension or high cholesterol;
They are of certain ethnicities, including Black, South Asian, Hispanic and a few others.
Gestational diabetes has its own set of risk factors as well. These include:
Being overweight with a body mass index (BMI) of over 30;
Being aged 25 or over;
Having suffered from the condition in the past;
Have given birth to a baby that weighed 9.9 pounds (4.5 kg) or more;
Have first degree family members (parents or siblings) with the type 2 version of the disease
Being of south-Asian, Black or Middle Eastern ethnicity
Although some of the symptoms experienced by diabetics are common to all forms of the disease, there are others that are specific to the type 1 or 2 forms of the condition.
The symptoms that are common to all forms of diabetes include:
Increased hunger and thirst;
A tendency to lose weight;
A need to urinate frequently;
A tendency to feel fatigued for no apparent reason;
Skin sores that do not respond well to treatment..
There are also symptoms specific to both men and women:
Male diabetics tend to experience a loss of sex drive, erectile dysfunction and loss of muscle strength;
Female diabetics tend to be afflicted by conditions such as urinary tract infections (UTIs), yeast infections and dry, itching skin.
Finally, there are some symptoms that are specific to the type 1 and 2 variations of diabetes:
Type 1 diabetics are more likely to experience extreme hunger and thirst and unplanned weight loss. They are also more likely to be affected by the need to urinate frequently as well as by blurred vision and tiredness. In addition, some type 1 diabetics may suffer mood swings;
Type 2 diabetics will experience similar symptoms as type 1 patients but will also experience chronic tiredness and bodily sores that resist attempts to treat them.
Gestational diabetics tend not to show any overt symptoms. Instead, this condition is usually detected by blood sugar or glucose tolerance tests carried out during pregnancy.
Diabetes is generally diagnosed by directly measuring blood sugar levels:
A fasting plasma glucose test can be performed to measure blood sugar levels after the patient has fasted for around 8 hours;
Testing the level of A1C (HbA1C) in the blood can also give doctors an idea of how blood sugar levels have varied over the past 3 months.
A1C levels have not been shown to be reliable for diagnosing diabetes in children.
Treatment Of Diabetes
Diabetes can generally be treated by either medication or lifestyle changes (as well as both)
For this version of the condition, insulin is the main treatment (since these patients are not able to produce enough insulin in the first place).
The insulin can be any of four types:
Rapid acting (starts working within 15 minutes and lasts for 3-4 hours)
Short acting (takes a little longer to start acting but then lasts for 6-8 hours);
Intermediate acting, which starts in 1-2 hours but then lasts for 12-18 hours;
Long acting, which may take a few hours to start working but can then last as long as 24 hours or longer.
Type 2 diabetes is felt by many doctors to be better treated by lifestyle changes, and so this is the option that will be tried first.
However, if lifestyle changes do not produce sufficiently rapid improvements, doctors can prescribe a variety of drugs to directly lower blood sugar. A couple of examples of these are Biguanides (which reduce the amount of glucose manufactured by the liver) and SGLT2 inhibitors (which cause the body to excrete more glucose in the urine). Other anti-diabetic drugs
However, there are many more drugs besides these two examples. These include sulfonylureas, pioglitazones and DPP-4 inhibitors (gliptins). The medicines have different mechanisms of action. A doctor can take the patient through the entire range of options and then make a recommendation.
In many countries, a biguanide like metformin is the first line drug and patients are usually started on this first if adequate control of the diabetes is not achieved through lifestyle changes alone.
Dietary changes to control type 1 diabetes generally focus on restricting the amount of carbohydrates consumed, as these are turned into sugar as part of the body’s metabolic process. If less carbohydrate is consumed and turned into sugar, there will be less need for insulin to remove the excess glucose from the blood.
Type 2 diabetics can also gain better control over blood sugar levels by eating less carbohydrates. In general, a healthy and more balanced diet that includes fresh fruit and vegetables and whole grains can help.
Most importantly, those with type 2 diabetes can try to increase their intake of lean protein and healthy fats as an alternative to carbohydrate consumption.