Diabetes

Diabetes mellitus represents a metabolic condition associated with hyperglycemia, which refers to abnormally high glucose levels in the blood. There are two situations that could lead to diabetes. First, the pancreas produces a little amount or does not produce the necessary insulin, a hormone responsible for transforming glucose or blood into energy for the body. This form of diabetes, also known as insulin-dependent appears more frequently during childhood and adolescence but it becomes a matter of discussion later in life. Secondly, the body is not able to give the normal response to the insulin produced by the pancreas. In comparison to the first form of diabetes, this noninsulin-dependent condition affects mostly adults and sometimes adolescents. Moreover, it is accountable for approximately 90% of all diagnosed cases in the world. Both of these situations, if left untreated, could cause major damages to the body’s systems and their organs including heart, kidneys, eyes, nerves and teeth. Complications of diabetes on the long term include loss of vision, renal failure, diabetic neuropathy and foot ulceration. People with diabetes experience increased thirst and urinations as well as unintentional weight loss. Generally, doctors measure the glucose level in the blood and recommend a healthy diet, regular exercise and certain medications.

 

Types of Diabetes

Type 1 diabetes, also called insulin-dependent diabetes or juvenile diabetes, represents an autoimmune condition because the body attacks and damages the pancreas with antibodies, making it unable to produce insulin.  The main factors that could lead to this type of diabetes include genetic predisposition along with certain viruses and other environmental factors. Although usually children and adolescents are safe targets of this condition, adults can also develop it, thus becoming vulnerable to several medical risks including heart disease and stroke as well as diabetic retinopathy, neuropathy and nephropathy. They suddenly experience common symptoms and signs of diabetes like blurred vision, extreme hunger, increased thirst, weight loss, frequent urination, weakness and fatigue, mood changes. Unfortunately, researchers have not yet discovered a cure. Nevertheless, doctors do have a treatment meant to control the disease and prevent the appearance of complications. Apart from changes in his lifestyle, the patient must give the body insulin by injecting it into the adipose tissue below the surface of the skin through various methods like syringes, jet injectors or insulin pens and pumps. The patient can live actively just by constantly paying attention and monitoring his blood glucose.

Type 2 diabetes, also called noninsulin-dependent diabetes or adult-onset diabetes, is a more common but milder form of diabetes that impedes the body to metabolize glucose or sugar, which represents an important source of energy. Whether the pancreas produces an insufficient amount of insulin or the body resists the effects of this natural hormone, the truth is that on the long term it could provoke major health complications. Even though it usually develops in adults, it also affects obese people of all ages including children because they present insulin resistance, which occurs mainly in fat so the pancreas is forced to double the amount of work in order to produce the necessary insulin and it still fails to keep sugar levels normal. The symptoms develop slowly meaning that a person can have diabetes and not realize until a few years later. They usually notice changes in their body and behavior, such as eating, drinking water and urinating more than usual, losing calories inexplicably, tiredness and irritation, inability to focus, frequent infections and sores, patches of dark skin. Similarly to the first type of diabetes, this condition does not have a cure but with a balanced diet and exercising, the patient can manage it successfully. Sometimes, insulin therapy and medications must be added to the treatment in order to control the progression of the disease.

Gestational diabetes occurs during pregnancy and influences the way cells use sugar, which circulates through the placenta to the unborn child so in order to ensure his normal growth and development, the expectant woman has to watch her diet and take insulin or medication, if needed. Although soon after delivery the sugar level comes back to normal, some women are prone to developing type 2 diabetes in the future, a few weeks or even years later. However, the baby suffers greater risks that his mother including abnormal weight gain, breathing problems at the moment of birth and the possibility of developing diabetes later in life. Because of the overly large baby, the doctor has to perform a cesarean section. Specialists do not know a specific cause that leads to gestational diabetes, but they do warn that some factors like age, usually over 25, excess weight and personal or family medical history can contribute significantly.

 

Complications Associated with Diabetes

Cardiovascular disease: Diabetes increases significantly the possibility of developing various cardiovascular problems like angina, defined by pressure or chest pain caused by obstruction of the coronary arteries, atherosclerosis, which refers to the narrowing of arteries, heart attack or stroke. Obesity, high blood pressure and smoking represent factors that increase the risk for heart disease in people with diabetes.

Retinopathy: Diabetes mellitus negatively affects the tiny blood vessels in the retina, potentially leading to vision loss. Multiple studies have demonstrated that some people dealing with diabetes for at least 15 years develop serious visual handicap while approximately 2% of them must face blindness. Other eye damages patients experience include glaucoma and cataracts. In order to prevent loss of vision, early detection and treatment is necessary, more exactly, consistent and thorough eye examinations along with medical intervention, which may require laser treatment or surgery.

Neuropathy: Apart from the blood vessels in the retina, diabetes provokes injuries to the capillaries, which represent an interweaving network that distributes nourishing substances for the nerves, especially in the lower limbs. Consequently, the patients experience numbness, tingling and even pain in their fingers that gradually spreads upwards. Without medical attention and care, they could lose the sense of feeling in their legs entirely. By damaging the nerves associated with digestion, this condition can lead to vomiting, nausea, constipation or diarrhea. It also represents a major cause for erectile dysfunction in men.

Nephropathy: Kidneys have the mission to filter waste from the blood with the help of uncountable small blood vessel clusters. This complex and sensitive filtering system becomes vulnerable in front of diabetes mellitus and can suffer major damage, eventually leading to renal failure or irreversible kidney disease. As a result, the patient must go through a procedure called dialysis, which has the purpose to substitute many important functions of the kidney or a transplant. Screening allows early detection of nephropathy, which can help prevent this condition. Furthermore, several methods including control of high blood pressure and glucose, restriction of dietary protein and medication can also decelerate the progression of renal damage.

Foot damage: Because of the harmful changes in the nerves and blood vessels, diabetes mellitus increases the possibility of experiencing various foot complications. Without a regular inspection and proper treatment, blisters and cuts generally develop severe infections with poor healing that ultimately require amputation.

Other complications related to diabetes mellitus refer to skin problems including fungal and bacterial infections, hearing impairment and Alzheimer’s disease, which represents a negative consequence of the type 2 diabetes. This serious and costly condition becomes more and more common in developing countries and underprivileged minorities. However, awareness of the symptoms and risk factors of diabetes represents a step for preventing and controlling its progress.

 

Tests and Diagnosis for Diabetes

Because a person with type 1 diabetes experiences sudden symptoms, doctors track down easily the condition by checking the sugar level in the blood. However, other types of diabetes manifest gradually and are not that obvious. For this particular reason, the American Diabetes Association recommends screening for anyone over the age of 45 or anyone presenting various risk factors of diabetes including high blood pressure and high cholesterol level, history of cardiovascular disease and diabetes in pregnancy, a sedentary life.

Common tests for diabetes

  • Fasting plasma glucose test consists in taking and closely analyzing a sample of blood and provides reliable results when performed in the morning because it requires the patient to abstain from food for at least eight hours.
  • A1C test, also known as hemoglobin A1C, glycated hemoglobin and glycosylated hemoglobin helps the doctor measure the average blood sugar level over the past three months. He will also consider the patient’s age and the possibility of anemia, which usually leads to inaccurate results. In this case, the patient has the permission to eat and drink before the test.
  • Oral glucose tolerance test resembles the fasting plasma glucose test because the patient has to fast overnight, more exactly at least eight hours. The doctor gives the patient a liquid containing a certain amount of glucose, namely 75 grams and for the next two hours, takes multiple blood samples to determine if the sugar level is abnormally high.
  • Random plasma glucose allows the doctor to test the patient when he notices the presence of concerning symptoms including unexplained weight loss, increased thirst and urination, fatigue and blurred vision. It does not require overnight fasting.

 

Treatment for Diabetes

Fortunately, there is a treatment for diabetes. People with diabetes can live a long and active life by following certain safety measures. Because diabetes causes damage to blood vessels and nerves, it practically affects every part of the body. Thus, they have to manage the blood glucose level throughout the day and night, cholesterol and blood pressure in order to prevent the appearance of severe complications. According to the type of diabetes, oral medications and insulin may become an important part of their treatment plan.

  • Healthy eating: Even though it may sound quite surprising, patients with diabetes do not have to observe a strict and specific diet. Nevertheless, focusing on vegetables, fruits and whole grains is beneficial because these types of foods are nutritious, with low fats and calories. In addition, eliminating or reducing the consumption of animal products and sweets is very important and helpful. Understanding the right amount of food can be challenging so a registered dietitian can easily develop a meal plan corresponding the needs, preferences and lifestyle of the patient.
  • Physical activity: Even though specialists recommend regular exercise for everyone, people with diabetes need it more in order to lower their sugar level by transforming it into fuel for the body. Moreover, it increases sensitivity to insulin meaning that the body does not need as much insulin to carry sugar to the cells and produce the necessary energy. The patient has the possibility to choose favorite activities like taking long walks, biking or swimming and making them part of his daily schedule.

 

Treatments for Type 1 and Type 2 Diabetes

  • Monitoring blood glucose: According to the doctor’s instructions, the patient may have to verify and register the sugar level several times a week or even eight times a day to ensure that it stays within his target range. Careful management is imperative but sometimes glucose levels can change unexpectedly in response to illness, medications, stress, food and physical activity and the patient must be aware of it. Besides daily monitoring, the doctor can recommend frequent A1C testing.
  • Insulin therapy: There are many types of insulin, such as rapid-acting, long-acting and intermediate options and sometimes doctors can advise a combination between them for use throughout the day and night. Patients cannot take insulin orally because of stomach enzymes which interfere with its action. However, doctors inject it using a fine needle, syringe or insulin pump, a device of a cell phone size that patients must wear outside their bodies.

 

Treatments for Gestational Diabetes

In order to ensure the unborn child’s health and prevent diabetes complications at the moment of birth, women with diabetes must control their blood sugar level at all costs. The prevention plan may include, apart from observing a healthy diet and exercising, taking medications or using insulin. A health care provider will have the mission to keep a check on the future mother’s blood glucose level during labor. A rising of the blood sugar represents a sign that the baby releases high levels of insulin meaning that immediately after birth the woman will present low blood sugar.

AAOM Editor

Academic Association of Medicine is the go to resource for all health related issues. We are an independent body that seeks to offer general information on various health topics and unbiased reviews on health products.

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