Diabetes

Diabetes mellitus (DM), is the most common chronic disorder characterized by high blood sugar levels. It has become a public burden. The number of people getting diabetes is increasing year by year due to lifestyle modifications. Diabetes occurs due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced.

There are three main types of diabetes mellitus, Type 1 DM, Type 2 DM, and Gestational Diabetes.

• Type 1 DM results from the failure of the pancreas to produce enough insulin.

• Type 2 DM occurs due to insulin resistance, a condition in which cells fail to respond to insulin properly.

• Gestational Diabetes occurs in pregnant women without a previous history of diabetes.

Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. If left untreated, diabetes can cause many complications. Acute complications can include diabetic ketoacidosis, nonketotic hyperosmolar coma, or death. Serious long-term complications include heart disease, stroke, chronic kidney failure, foot ulcers, and damage to the eyes.

Diagnosis of the diagnosis is very important as it can affect other systems and can become life-threatening. Diagnosis is mainly by measuring the blood sugar levels fasting and post-prandial blood sugars. When diabetes is diagnosed at borderline stages can be prevented by following a proper diet and lifestyle modifications. In patients with diabetes treatment includes medications like anti glycaemic drugs and insulin depending on the requirement.

Diabetes: Causes

The following are the essential causes of developing diabetes −

• Insulin is the principal hormone that regulates the uptake of glucose from the blood into cells of the body, especially the liver, adipose tissue, and muscle, except smooth muscle. Insulin plays a critical role in balancing glucose levels in the body. It helps in the utilization, storage, and breakdown of glucose.

• Insulin is released into the blood by beta cells (β-cells), found in the islets of Langerhans in the pancreas, in response to rising levels of blood glucose, typically after eating and is low when the glucose levels are low

• Type 1 diabetes mellitus is characterized by the loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas, leading to insulin deficiency either due to an autoimmune attack leads to the loss of beta cells and thus insulin or because of idiopathic reasons.

• Type 1 diabetes is partly inherited, with multiple genes, including certain HLA genotypes, known to influence the risk of diabetes.

• In genetically susceptible people, the onset of diabetes can be triggered by one or more environmental factors, such as a viral infection or diet.

• Type 2 DM is characterized by insulin resistance that occurs due to lifestyle factors and genetics.

• Lifestyle factors such as obesity, lack of physical activity, poor diet, stress, and dietary factors influence the risk of developing type 2 DM

• Gestational diabetes mellitus involves a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2–10% of all pregnancies and may improve or disappear after delivery.

Diabetes: Symptoms

Symptoms of diabetes may develop rapidly over weeks to months in type 1 DM, while they usually develop much more slowly and may be subtle or absent in type 2 DM.

The classic symptoms of untreated diabetes include −

• Loss of weight

• Polyuria is increased urination

• Polydipsia is increased thirst

• Polyphagia is increased hunger

Other symptoms include −

• Blurring of vision

• Frequent Headache

• Fatigue

• Slow healing of cuts and minor wounds

• Itchy skin.

• Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting in vision changes.

• Several skin rashes that can occur in diabetes are collectively known as diabetic dermadrome

Symptoms occurring due to complications of diabetes include −

• Diabetes doubles the risk of cardiovascular disease and stroke.

• Damage in small blood vessels includes damage to the eyes, kidneys, and nerves. Causing diabetic retinopathy, presenting with gradual vision loss and blindness.

• Damage to the kidneys, known as diabetic nephropathy, can lead to tissue scarring, urine protein loss, and eventually chronic kidney disease, sometimes requiring dialysis or kidney transplant.

• Damage to the nerves of the body, known as diabetic neuropathy, presents with numbness, tingling, pain, and altered pain sensation, which can lead to damage to the skin. Diabetic neuropathy causes painful muscle wasting and weakness in Diabetic Amyotrophy.

• Diabetes-related foot problems such as diabetic foot ulcers) may occur and can be difficult to treat, occasionally requiring amputation.

Diabetes: Risk Factors

Several factors play an essential role in the development of diabetes which include −

• An individual with a family history of diabetes

• Type 1 DM affects younger age groups and type 2 DM affects adults and older people.

• An improper diet containing oily items, junk foods, sweets, and fried items

• Lack of physical activity

• Obesity

Diabetes: Diagnosis

The diagnosis of the diagnosis is done as follows −

• Fasting plasma glucose level >126 mg/dl. Postprandial glucose levels >200 mg/dl that is two hours after a 75 g oral glucose load confirms diabetes. In prediabetic patients, FBS is between 100 -126mg/dl and PPBS is between 140-200mg/dl

• Glycated hemoglobin (HbA1C) ≥ 6.5 DCCT %

• The oral Glucose Tolerance Test measures the body's ability to metabolize glucose. The patient is asked to take a glucose drink and their blood glucose level is measured before and at intervals after the sugary drink is taken.

• People with impaired glucose tolerance show fasting values of 6.0 to 7.0 mmol/L and at 2 hours 7.9 to 11.0 mmol/L. In diabetes fasting values over 7.0 mmol/L and at 2 hours over 11.0 mmol/L

Diabetes: Treatment

The treatment is based on the severity of the symptoms. Your doctor may advise conservative or surgical treatment.

Conservative Treatment

Conservative treatment includes −

• Lifestyle modifications such as diet modifications, regular exercise, and maintaining a healthy weight

• Medications include anti glycaemic drugs

Surgical Treatment

Surgical treatment may be required in severe cases where the diet and medications don’t help the individual with the condition. Depending on the condition the surgeries required may be −

• Transplantation of the pancreas

• Transplantation of kidneys

• Bariatric surgeries in obesity patients

Diabetes: Prevention

Some of the measures that can help to prevent diabetes include −

• A healthy well balanced diet including a lot of dietary fiber, fruits, and vegetables

• Avoid junk foods

• Avoid smoking and alcohol consumption

• Regular physical activity such as regular walking and exercises

• Maintain a healthy body weight

Conclusion

Diabetes is a chronic health condition that occurs due to increased levels of glucose in the body. It occurs due to the less or absent production of insulin by the pancreas either due to an autoimmune attack or due to idiopathic causes or developed resistance to the insulin secondary to lifestyle factors and genetics.

The classic symptoms of untreated diabetes include Loss of weight, increased urination, increased thirst, and increased hunger. Additional symptoms are present depending on the organ affected and the complication present.

The criteria to diagnose diabetes include fasting blood sugar of more than 126mg/dl, Postprandial blood sugar of more than 200mg/dl, and HbA1c of more than 6.5. Diabetes can be controlled by following a properly balanced diet, regular activity, and by taking medications regularly. Surgery may be required in some cases. Prevention by lifestyle modifications is very important in diabetes.