What is Diabetes?
Diabetes is a chronic metabolic disorder characterized by hyperglycemia, the presence of high sugar (glucose) levels in the blood. The level of glucose in the blood is regulated by the insulin hormone. The normal level of glucose in the blood should be between 4 -5.6 mmol/l (fasting) and < 7.8mmol/l (random). (There are different views about the normal range of blood glucose. Please discuss the same with your healthcare team.) Impaired production or function of insulin increases glucose levels in the blood.
There are 3 types of diabetes:
- Type 1 diabetes is an autoimmune disease, in which the insulin-producing cells are mistakenly killed by the body’s defence system; hence, decreasing the production of insulin and increasing the accumulation of blood sugar.
- Type 2 diabetes occurs either due to the reduced production of insulin or the inadequate use of the hormone produced by the various cells of the body. This is termed as insulin insensitivity and is the most common type of diabetes.
- Gestational diabetes is a temporary condition, which occurs during pregnancy. Gestational diabetes resolves after childbirth but poses a future risk for the development of type 2 diabetes in the mother.
Anatomy of Pancreas
The pancreas is situated just below the stomach and produces enzymes for the digestion of food, and the hormones insulin and glucagon for the regulation of blood glucose. The pancreas consists of a group of cells called the islets of Langerhans, which produce and store the hormone. Carbohydrates in the food we eat are broken down to form glucose, which is either used immediately by the muscles and liver as energy or stored for later use. When levels of blood sugar start rising after a meal, the islets of Langerhans secrete insulin, which transports sugar to the cells. If the pancreas fails to produce sufficient amounts of insulin or the body’s cells are insensitive to the hormone, glucose starts accumulating in the bloodstream, leading to diabetes.
Causes of Diabetes
The various causes of diabetes include:
- Sedentary lifestyle
- Viral infection or nutritional factor in childhood
- Old age
- High blood triglyceride levels
- Autoimmunity, when the body’s defence system attacks and destroys pancreatic cells
Diabetes causes damage to the cardiovascular system, vision, kidneys, nerves, feet, hearing, skin, and blood vessels. Gestational diabetes can lead to complications such as high birth weight, requiring C-section delivery, and preeclampsia or high blood pressure that could be life-threatening for both mother and child.
Symptoms of Diabetes
The common symptoms of diabetes mellitus are increased thirst, frequent urination, extreme hunger, unexplained weight loss, fatigue, blurred vision, delayed wound healing, dehydration, altered mental status, and frequent infections.
Stages of Diabetes. (Type 1 diabetes is NOT precluded by pre-diabetes.)
- Normal = fasting plasma glucose <5.5mmol/l or an HbA1C of less than 6% or < 42mmol/mol
- Pre-diabetes ( previously called impaired glucose tolerance or impaired fasting glucose) defined by a fasting plasma glucose of 5.5-6.9mmol/L or HbA1C 6-6.4% or 42-47mmol/mol.
- Diabetes= fasting plasma glucose>/= 7mmol/L or a random plasma glucose >/= 11.1mmol/L or HbA1C >/= 6.5% or 48mmol/mol
- In the UK we now use HbA1C to diagnose and monitor diabetes in most situations.
- Diagnosis requires one test within the above range and symptoms (such as thirst, urinary frequency and increased volume, tiredness, frequent thrush infections, blurred vision.
- If there are no symptoms the test should be repeated before diagnosis is made.
- Sometimes an oral Glucose Tolerance test is done The 2 hour post OGTT result confirming diabetes is >/= 11.1mmol/L or in pregnancy >/= 7.8 or a fasting plasma glucose of 5.6mmol/L or above.
When left untreated, diabetes can damage various parts of the body:
- Eyes: Diabetic retinopathy, cataracts, and glaucoma
- Kidney: diabetic nephropathy, progressive renal failure
- Nerves: diabetic neuropathy and erectile dysfunction
- Cardiovascular diseases: Early coronary artery disease, peripheral vascular disease, hypertension and ischemia
- Feet: Increased risk of infections and foot ulcers
- Slow wound healing, many times necessitating amputation
Treatment of Diabetes
Treatment of diabetes involves diet, exercise, medications and other lifestyle improvements. These will help to maintain normal blood sugar levels and prevent or minimize complications of diabetes.
- Diet: Eat a consistent well-balanced diet that is high in fibre, and low in saturated fats and concentrated sweets. Meals should be taken on a regular schedule and long periods between eating should be avoided.
- Exercise: Regular exercise in any form can help maintain a healthy weight and blood sugar levels within the normal range.
- Smoking and alcohol use: Stop smoking and limit the consumption of alcohol.
- Medical treatment:
- Type 1 diabetes always requires Insulin treatment alongside careful dietary attention and monitoring.
- Type 2 Diabetes requires lifestyle interventions such as weight loss, dietary changes and exercise as well as oral medications and for some people injectable treatments including insulin.
- Treating comorbidities: Your doctor will also include medications and treatments to prevent, control and treat other associated conditions.
Regular monitoring of blood glucose is necessary to prevent long-term complications of the disease.
Some other treatments that are suggested to control diabetes include:
- Pancreatic transplantation: This method can be indicated for type 1 diabetes. If the pancreas transplant is successful, you would no longer require insulin. However, the treatment may have major side effects like organ rejection, which can be more fatal than diabetes itself. Hence, this treatment is suggested only in severe cases where diabetes cannot be controlled through any other means.
- Bariatric surgery: This is a weight loss surgery. Though it is not a direct treatment for diabetes, weight loss surgeries may help to reduce blood sugar in patients with a BMI of 35 and above.