Diabetes

Diabetes Mellitus is a group of diseases which affect how the body uses glucose or sugar. Glucose is a simple sugar in the blood and is the body’s main source of energy. The brain depends on glucose as its primary fuel.

There are many different types of Diabetes Mellitus, but in all types, there is too much glucose in the blood. The reason for this varies. Having too much glucose in the blood can cause serious problems.

Type 1 and type 2 diabetes are chronic conditions. Prediabetes is a condition in which a person’s blood sugar is higher than the normal levels, but not high enough to be considered diabetes. Gestational Diabetes is the presence of high blood glucose levels during pregnancy. This sometimes resolves after the birth of the baby.

Causes of Diabetes

In order to understand diabetes mellitus, it’s important to first know how glucose normally is processed by the body.

How insulin works

Insulin is a hormone. It is produced by the pancreas. The pancreas is an organ that sits below and behind the stomach.

• Insulin is secreted by the pancreas into the bloodstream
• Insulin in the blood allows glucose to exit the blood and enter the cells to give them energy.
• As the glucose goes into the cells, the amount of sugar in the blood decreases
• When blood sugar levels drop, the pancreas is signalled to decrease the secretion of insulin.

The role of glucose

Glucose provides energy for the body’s muscles and other tissue cells. The brain must have glucose in order to function.

• There are 2 primary sources of glucose: the food that is consumed and the liver also makes glucose.
• Glucose enters the bloodstream, and from there, with the help of insulin, it is absorbed by the cells.
• The liver is also able to manufacture and store sugar. Stored glucose in the liver is called glycogen
• When blood sugars levels fall, for example, when a person skips a meal, the liver starts to change the sugar it has stored (glycogen) into glucose to provide enough energy for your body.

Causes of Diabetes: Type 1

Exactly what causes the disease is not known. It has been discovered that the body’s immune system, which is responsible for fighting off infection, fights against and destroys the cells in the pancreas that make insulin. Without insulin, glucose can’t get into the cells that need it for energy, so it builds up in the bloodstream.

Type 1 Diabetes may be caused by a combination of factors including hereditary susceptibility and factors in the environment. It isn’t clear, however, what many of these factors are.

Causes of Diabetes: Type 2

In these conditions, the cells gradually become resistant to insulin. The pancreas can’t keep up with a demand to over-ride the resistance and so too much glucose is present in the bloodstream.

Like Type 1 Diabetes, why these conditions develop isn’t exactly clear. It is thought that hereditary and environmental factors play a part. Obesity is strongly associated with Type 2 Diabetes, but not all people who develop Type 2 Diabetes are overweight.

Causes of Diabetes: Gestational

When a woman is pregnant, hormones are produced by the placenta to sustain a pregnancy that makes cells more insulin-resistant. Normally, the pancreas produces enough insulin to take care of the resistance. But in some women, the pancreas is unable to keep up and too much glucose stays in the blood. This results in Gestational Diabetes.

Risk Factors

There are different risk factors for the different types of Diabetes.

Risk factors for Type 1 Diabetes

Even though the exact reason Type 1 Diabetes develops isn’t known, there are certain factors that increase the risk of the disease developing. These include:

• Family history: A person’s risk of developing diabetes is greater if a parent or a brother or sister has the disease.
• Environmental factors: If a person has been exposed to certain environmental factors, like a viral illness, it is more likely that Type 1 Diabetes will develop.
• Specific Auto-antibodies: These are specialized cells in the immune system. Some people whose parents or siblings have Type 1 Diabetes are tested for the presence of these. If present, the person may have a greater likelihood of becoming a Type 1 Diabetic. However, not all people with autoantibodies specific for diabetes become diabetic.
• Diet: Dietary factors that have been associated with an increased risk of Diabetes Type 1 include consumption of cow’s milk or formula containing cow’s milk early in life, early consumption (before 4 months of age) of cereals and low intake of vitamin D. These factors alone do not cause Type 1 Diabetes.
• Geography: Living in certain countries increases the risk of the disease. Sweden and Finland have increased rates of Type 1 Diabetes.

Risk factors for pre-Diabetes and Type 2 Diabetes

Even though the exact cause of Type 2 Diabetes isn’t known, there are factors that certainly increase a person’s risk for the Disease. They include:

• Weight: Being overweight increases the risk for Type 2 Diabetes as overweight and obesity lead to insulin resistance.
• Inactivity: People who have sedentary lifestyles are at increased risk for Diabetes. Physical activity helps make the cells of the body more sensitive to insulin, it uses glucose for energy and it helps with weight control.
• Family history: A person’s risk of developing Diabetes is greater if a parent or a brother or sister has the disease.
• Race: It is not clear why, but certain ethnic groups are at an increased risk of developing Type 2 Diabetes. Groups at increased risk include American Indians, African Americans, Hispanics and Asian-Americans.
• Age: The risk of developing Type 2 Diabetes increases with age, possibly due to the loss of muscle mass and weight gain. In recent years, Type 2 Diabetes is dramatically increasing in younger adults, adolescents, and children as well.
• Gestational diabetes: Women who develop Gestational Diabetes or deliver infants that weigh more than 9 pounds are at increased risk for Type 2 Diabetes. Gestational Diabetes also increases the risk of pre-Diabetes.
• Polycystic Ovary Syndrome: Women who have this condition, also known as PCOS, are at increased risk for Diabetes. Signs and symptoms of PCOS include excessive hair growth, irregular menstrual periods and obesity.
• Hypertension: Having a blood pressure over 140/90 has been associated with an increased risk of developing Type 2 Diabetes.
• Low HDL Cholesterol and High Triglycerides: HDL is “good cholesterol.” Triglycerides are also a type of fat which is carried in the bloodstream. People who have low HDL cholesterol and high triglycerides are at increased risk of Type 2 Diabetes.

Risk factors for gestational diabetes

Gestational Diabetes can develop in any woman who is pregnant, however, the risk for the condition is greater in certain women. Some of the risk factors for Gestational Diabetes include:

• Age: Being older than 25 years old increases the risk of Gestational Diabetes.
• Family or personal history: A woman is at increased risk for Gestational Diabetes if she has pre-Diabetes or if a parent or brother or sister has Type 2 Diabetes. The risk for Gestational Diabetes is also greater if the condition was present in a prior pregnancy, an unexplained stillbirth occurred or if the woman previously delivered a baby weighing over 9 pounds.
• Weight: Women who are overweight before becoming pregnant are at increased risk for Gestational Diabetes.
• Race: It is unknown why, but women of certain races are at increased risk for the condition. These races include African-American women, American Indian women, and Asian and Hispanic women.

Complications

The long-term complications of Diabetes come on slowly and develop over time. The risk of diabetic complications increases with the length of time a person has Diabetes. Having poorly-controlled blood glucose levels also increases the risk for complications of the disease. Complications associated with Diabetes can eventually become disabling. Some are even life-threatening. Possible complications of diabetes include:

• Cardiovascular Disease: Diabetes significantly increases a person’s risk of many cardiovascular problems, like heart disease and stroke. Cardiovascular complications of diabetes include:
  • Coronary artery disease accompanied by angina (chest pain)
  • Atherosclerosis (narrowing of the arteries)
  • Heart attack
  • Stroke
• Nerve damage: This is known as Neuropathy. Too much sugar eventually damages the capillaries (tiny blood vessels) that supply blood to the nerves. This is most common in the extremities. When the nerves aren’t nourished and are damaged symptoms develop such as numbness, tingling, pain, or burning sensations. This typically starts in the tips of the fingers or toes and spreads in toward the center of the body. If it isn’t treated, neuropathy can cause the loss of feeling in the arms or legs that are affected. If the digestive nerves are damaged, problems such as vomiting and nausea, constipation or diarrhea can result. Neuropathy in men can sometimes cause erectile dysfunction.
• Kidney damage: This is known as Nephropathy. Countless clusters of tiny blood vessels are called glomeruli and lie deep inside the kidneys. These are specialized filters that clean waste products out of the blood. Damage caused by Diabetes can affect the way this filtering system works and lead to the buildup of toxins in the blood. The end result is kidney failure which may make dialysis or a kidney transplant necessary
• Eye damage: Diabetic Retinopathy is damage caused to the blood vessels that nourish the retina of the eye. This can cause blindness if not treated. Diabetes also increases the risk of glaucoma and cataracts.
• Foot damage: Impaired blood flow or nerve damage to the feet due to Diabetes leads to increased risk of serious complications. Injuries can occur without a person’s knowledge due to the loss of sensation. Wounds and sores on the feet can be difficult to heal due to poor circulation and even small cuts can quickly become infected. Left untreated, and sometimes even with treatment, amputation of toes, portions of the foot or the leg is required.
• Skin conditions: Diabetes increases the risk for skin impairments, such as fungal and bacterial infections.
• Hearing impairment: People who have Diabetes are at higher risk for problems with hearing.
• Alzheimer’s disease: The risk of developing Alzheimer’s disease seems to be associated with Type 2 Diabetes. People with poorer blood glucose control seem to be at the greatest risk. These theories have not yet been proven and more research is needed.

Complications of Gestational Diabetes

In most cases, women with Gestational Diabetes have healthy babies. If Gestational Diabetes is poorly controlled, however, complications can develop for both the mother and her baby.

Possible complications for a baby as a result of Gestational Diabetes include:

• Excessive growth: If a mother’s blood sugar is uncontrolled, the excess glucose crosses the placenta. This stimulates the unborn baby’s pancreas to produce extra amounts of insulin which causes excessive growth of the baby (Macrosomia). Babies that are very large often need a C-section birth.
• Low blood sugar: Since the baby’s pre-birth insulin production was high, once they are born and don’t have their mother’s supply of glucose, their blood sugar level can rapidly fall. This is often corrected by intravenous glucose and prompt feeding.
• Type 2 diabetes later in life: Babies whose mothers had Gestational Diabetes are at higher risk of eventually becoming obese and developing Type 2 Diabetes.
• Death: Gestational Diabetes that is not treated places an infant at increased risk of death, either shortly after or before it is born.
• Possible complications for a mother as a result of Gestational Diabetes include:
• Preeclampsia: Preeclampsia is a condition that is characterized by elevated blood pressure, swelling of the feet and legs and excessive amounts of protein in the urine. It can be a life-threatening complication for both the infant and the mother.
• Subsequent Gestational Diabetes: Having Gestational Diabetes with one pregnancy makes it more likely that a mother will have it again with subsequent pregnancies. Women who have Gestational Diabetes are also more likely to develop diabetes (most often Type 2 Diabetes) as they age.

Complications of prediabetes

Having pre-Diabetes increases the risk of developing Type 2 Diabetes.

Diabetes – Symptoms

The symptoms of Diabetes often depend on how high the level of glucose is in the blood. People who have Type 2 Diabetes or pre-Diabetes may not experience any symptoms until they have had the condition for quite a long time. In Type 1 Diabetes, the Diabetes symptoms in men usually are more severe and come on rapidly.

Diabetes symptoms in men and women of both Type 1 and Type 2 Diabetes may include:

• Frequent need to urinate
• Increased thirst
• Increased appetite
• Unintentional weight loss (more common in Type 1 Diabetes)
• Irritability
• Fatigue
• Sores or ulcerations that won’t heal or heal very slowly
• Changes in vision
• Frequent infections, for example, skin infections, sores or infections of the mouth or vaginal area

Type 2 Diabetes symptoms in men are more common than Type 1. It typically occurs in people over the age of 40 years, although it is being seen with increasing frequency in those who are much younger. Type 1 Diabetes can develop at any age, but most often it develops in young children or adolescents.

Signs of trouble in any type of Diabetes

Many different factors can affect blood sugar levels, so problems sometimes occur that need immediate attention. These diabetes symptoms in men include:

• High blood glucose (Hyperglycemia): Many conditions can elevate your blood glucose level. These include:

a) Not taking your diabetes medication

b) Illness

c) Eating too much

d) Exercise can sometimes cause elevated blood glucose levels

• Ketones in your urine (Diabetic Ketoacidosis): This condition is more common in Type 1 Diabetes. When your cells don’t have any fuel to use for energy, your body sometimes starts to burn fat. This process results in the production of waste products which are acidic. They are called ketones and the body gets rid of them in the urine. They accumulate in the bloodstream and cause the following diabetes symptoms in men and women:
  • Loss of appetite
  • Vomiting
  • Weakness
  • Stomach pain
  • Fever
  • A sweet, fruity odor on the breath

Diagnostic Procedures

The Diabetes symptoms in men and women of Type 1 Diabetes typically come on suddenly. These diabetes symptoms in men and women are often the reason blood glucose levels are checked. Other types of Diabetes and pre-Diabetes develop more slowly in most cases, and no diabetes symptoms in men and women may initially appear. This is why the American Diabetes Association (ADA) recommends guidelines for screening for Diabetes. The ADA guidelines recommend the following individuals be screened for Diabetes:

• Any person, of any age, whose body mass index (BMI) is greater than 25 who also has other risk factors. These additional risk factors include:
  • High blood pressure
  • High blood cholesterol levels
  • A history of heart disease
  • A sedentary lifestyle
  • A history of gestational diabetes (diabetes while pregnant)
  • A history of polycystic ovarian syndrome (PCOS)
  • A history of delivering a baby weighing over 9 pounds
  • A family history of diabetes
• Any person over the age of 45 years. The ADA recommends an initial screening for people over the age of 45. If this is normal, the person is then to be screened every 3 years.

Testing for Type 1 and Type 2 Diabetes and pre-Diabetes

• A1C (Glycated Hemoglobin) test: This is a blood test that tells your health care provider average blood glucose level over the past two to three months. This test is measured in a percent. It indicates the percentage of blood glucose attached to the hemoglobin in your blood.
• Random blood sugar test: This is a sample of the blood sugar taken at a random time, regardless of when you last had anything to eat or drink. A random blood glucose level of 200 mg/dl or higher is suggestive of Diabetes.
• Fasting blood sugar test: This is a blood test taken when you are fasting. Normal results are less than 100 mg/dl. A fasting blood sugar of 126 mg/dl or higher on 2 separate occasions indicates diabetes. A fasting blood glucose of 100 to 125 mg/dl indicated pre-Diabetes.
• Oral glucose tolerance test: This test involves a fasting blood sugar, followed by the technician having you drink a syrupy liquid. When your glucose levels are checked at intervals over the next few hours.

Testing for Gestational Diabetes

Doctors evaluate a woman’s risk for Gestational Diabetes early in pregnancy. Women who are at high risk for the condition may be tested for Diabetes at their first prenatal visit. Women who are at high risk for Gestational Diabetes include those women who:

• Are overweight or obese when they become pregnant
• Have a history of Gestational Diabetes
• Have a parent, child, or brother or sister with Diabetes

Screening tests for Gestational Diabetes symptoms in men and women may include:

• Initial glucose challenge test: This test involves drinking a sugary liquid. Your blood sugar level is checked one hour after drinking this liquid. Normal results of this test vary but are usually considered normal if they are below 140 mg/dl.
• Follow-up glucose tolerance testing: The follow-up test involves a fasting blood glucose level followed by drinking another syrupy solution. This liquid has a higher glucose concentration. Your blood glucose will be checked hourly over three hours. In order to be diagnosed with Gestational Diabetes, two of the three blood glucose levels will need to be above normal.

Diabetes – Care and Treatment

Diabetes care depends on what type of the Disease has been diagnosed. Monitoring your blood sugar, oral medications, and insulin may be a part of diabetes care. Maintaining a healthy weight, eating a nutritious diet and including some form of exercise in your daily routine are also important in managing the disease.

Treatments for Type 1 and Type 2 Diabetes

Type 1 Diabetes care includes the use of insulin, either injections or using an insulin pump, frequently monitoring blood sugar levels, and it often involves carbohydrate counting. Type 2 Diabetes care typically involves monitoring your blood sugar level, oral medications, insulin or both.

• Monitoring blood glucose levels: Depending on a person’s Diabetes care plan, blood glucose levels may be checked and recorded only several times weekly to as often as eight or more times daily. Monitoring your blood sugar is the only way to make sure it stays within your targeted limits. People who take insulin sometimes also use a continuous glucose monitor. This device doesn’t replace a glucose meter or glucometer, but it can help to detect trends in the blood glucose level.Blood glucose levels sometimes change unpredictably, even when diabetes is carefully monitored. Your Diabetes care team can help you discover how your diet, medications, activity, illness, stress, alcohol and other factors affect your blood sugar levels.A1C testing is also usually recommended in addition to blood glucose monitoring. This measures your blood sugar level over the past two to three months and can indicate how well your Diabetes care plan is working. If your A1C level is high, you may need an adjustment in your medication or eating plan. The ADA recommends an A1C goal of 7 percent or lower for diabetics, but your target may be different. A1C goals vary and can depend on your age, other medical conditions, and other factors.
• Insulin: People who have Type 1 Diabetes must have insulin and many individuals who have Type 2 Diabetes care also require insulin. Women with Gestational Diabetes care may also need insulin therapy.There are many different types of insulin. They include long-acting insulin, rapid-acting, and intermediate insulin. Depending on what your body needs, your health care provider may prescribe a combination of different types of insulin.Enzymes in the stomach destroy insulin, so it can’t be taken in the form of an oral pill. Often insulin is taken by injection, involving the use of a syringe and very small needle or an insulin pen. Insulin pens look like a larger-than-normal ballpoint pen.Some diabetics use an insulin pump. An insulin pump is a small external device, worn on the outside of the body. It is about the size of a deck of cards and it connects to a reservoir of insulin. A tiny tube is inserted under the skin that connects to the insulin supply. Tubeless pumps have recently become available. The pump is programmed to deliver specific amounts of insulin and can be adjusted depending on the individual’s needs.
• Oral and other medications: Your health care provider may prescribe oral medications or other injected medications to manage your Diabetes care.
• Transplantation: Pancreas transplantation may be a Diabetes care option for some people who have Type 1 Diabetes. If a pancreas transplant is successful, insulin is no longer necessary.
• Bariatric surgery: People who have Type 2 Diabetes and are also obese (body mass index greater than 35) may benefit from bariatric surgery. This is not a specific Type 2 Diabetes care, but diabetics who have gastric bypass surgeries have significant reductions in blood glucose levels. Long-term benefits and risks are not yet known.

Gestational Diabetes care

Adequate control of your blood glucose level is vital to the health of your unborn baby and it will also help avoid complications during delivery. In addition to exercise and a healthy diet, your health care provider may recommend close monitoring of your blood glucose levels and, in some cases, taking oral medications or insulin.

Your blood glucose levels will also be monitored during labor. If your blood glucose rises, your baby may release significant amounts of insulin. This can lead to low blood sugar levels after delivery.

Pre-Diabetes care

Test kits are available over-the-counter to check your urine for the presence of ketones. If ketones are present in your urine, call your doctor right away or go to an emergency center.

• Hyperglycemic Hyperosmolar Nonketotic Syndrome: This condition is more common in Type 2 Diabetes care and it is a life-threatening emergency. Signs and Diabetes symptoms in men and women include:
  • Blood glucose level over 600 mg/dl
  • Extreme thirst
  • Dry mouth
  • Drowsiness
  • Fever
  • Impaired vision
  • Confusion and hallucinations

If you have signs of this condition, seek medical care immediately.

• Low blood sugar (Hypoglycemia): When blood glucose levels drop too low, Hypoglycemia is the result. This can happen for a variety of reasons including:
  • Missing a meal
  • Not eating enough
  • Exercising more than normal
  • The presence of too much insulin or oral medications in the body

To help avoid low blood sugar, monitor your blood glucose regularly. Watch for Diabetes symptoms in men and women of Hypoglycemia. These include:

• Sweating
• Shaking or trembling
• Slurred speech
• Hunger
• Weakness or drowsiness
• Dizziness or blurred vision
• Headache
• Irritability or confusion
• Heart palpitations
• Fainting or seizures

Hypoglycemia is treated with carbohydrates that can be absorbed quickly, like fruit juice, candy, glucose gel or tabs. If you have Diabetes, carry a source of quick-acting glucose with you at all times.

Alternative Medicine

In some research studies, numerous substances have been shown to help improve insulin sensitivity. Other studies on these same substances have failed to show they have any effect on blood glucose or A1C levels. Since the findings are not consistent, there are no alternative therapies currently being recommended to help manage blood glucose levels.

If you decide to try an alternative Diabetes care, do not stop the Diabetes care prescribed for you by your doctor. Be sure to ask your healthcare provider about any therapy you are considering to make sure it won’t interact with your current Diabetes care plan or cause an adverse reaction.

There is no cure for Diabetes. If you are currently taking insulin, don’t stop using it unless your doctor has directed you to do so.

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