What is diabetes?
Diabetes mellitus is a chronic condition (meaning that although it can be controlled, it lasts a lifetime) associated with disease of the pancreas, an organ behind your stomach that produces the hormone insulin. Insulin produced by the pancreas lowers blood glucose and helps the body use food for energy. Absence or insufficient production of insulin causes diabetes. Insulin works together with glucose (sugar) in the bloodstream to help it enter the body’s cells to be burned for energy. If the insulin isn’t functioning properly, glucose cannot enter the cells. This causes glucose levels in the blood to rise, creating a condition of high blood sugar or diabetes and leaving the cells without fuel.
Types of diabetes mellitus.
There are three major types of diabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes.
Type 1 diabetes mellitus – Here diabetes mellitus is hereditary. It is known as insulin-dependent or childhood-onset diabetes, which is characterized by a lack of insulin production. In type 1 diabetes, the pancreas makes little or no insulin, so sugar cannot get into the body’s cells for use as energy. People with type 1 diabetes must use insulin injections to control their blood glucose.
Type 2 diabetes mellitus – This is caused by lifestyle changes like regular consumption of unhealthy food plus sedentary life and an increase in weight. It is also called non-insulin-dependent or adult-onset diabetes. Diabetes mellitus is caused by the body’s ineffective use of insulin. Type 2 diabetes may sometimes be controlled with a combination of diet, weight management, and exercise. However, the treatment also may include oral glucose-lowering medications or insulin injections.
Gestational diabetes – Diabetes that’s triggered by pregnancy is called gestational diabetes (pregnancy, to some degree, leads to insulin resistance). It is often diagnosed in middle or late pregnancy. Because high blood sugar levels in a mother are circulated through the placenta to the baby, gestational diabetes must be controlled to protect the baby’s growth and development. Gestational diabetes affects about 4% of all pregnant women. Gestational diabetes usually resolves itself after pregnancy. It may precede the development of type 2 (or rarely type 1) diabetes. Up to 10% of women with gestational diabetes develop type 2 diabetes. It can occur anywhere from a few weeks after delivery to months or years later.
With gestational diabetes, risks to the unborn baby are even greater than risks to the mother. Risks to the baby include abnormal weight gain before birth, breathing problems at birth, and higher obesity and diabetes risk later in life. Risks to the mother include needing a cesarean section due to an overly large baby, as well as damage to the heart, kidney, nerves, and eye.
Treatment during pregnancy includes working closely with your health care team and:
- Careful meal planning to ensure adequate pregnancy nutrients without excess fat and calories
- Daily exercise
- Controlling pregnancy weight gain
- Taking diabetes insulin to control blood sugar levels if needed
All types of diabetes mellitus have something in common. Normally, your body breaks down the sugars and carbohydrates you eat into a special sugar called glucose. Glucose fuels the cells in your body. But the cells need insulin, a hormone, in your bloodstream to take in the glucose and use it for energy. With diabetes mellitus, either your body doesn’t make enough insulin, it can’t use the insulin it does produce or a combination of both.
Since the cells can’t take in the glucose, it builds up in your blood. High levels of blood glucose can damage the tiny blood vessels in your kidneys, heart, eyes, or nervous system. That’s why diabetes — especially if left untreated — can eventually cause heart disease, stroke, kidney disease, blindness, and nerve damage to nerves in the feet.
Symptoms of diabetes include:
- increased urine output
- hunger (Insulin is an anabolic hormone, that is, one that encourages the storage of fat and protein)
- fatigue, nausea, and vomiting
- Patients with diabetes are prone to developing infections of the bladder, skin, and vaginal areas.
- Fluctuations in blood glucose levels can lead to blurred vision. Extremely elevated glucose levels can lead to lethargy and coma.
- weight loss
- slow healing of sores or cuts
- dry mouth
What causes diabetes?
Health care providers do not yet know what causes diabetes. The following factors may increase your chance of getting diabetes:
- Family history of diabetes or inherited tendency
- Being overweight (20% or more over your desired body weight)
- Physical stress (such as surgery or illness)
- Use of certain medications, including steroid and blood pressure medications
- Injury to the pancreas (such as infection, tumor, surgery, or accident)
- Autoimmune disease
- High blood pressure
- Abnormal blood cholesterol or triglyceride levels
- Age (risk increases with age)
- Alcohol (risk increases with years of heavy alcohol use) and smoking
It is important to note that sugar itself does not cause diabetes. Eating a lot of sugar can lead to tooth decay, but it does not cause diabetes.
How is diabetes diagnosed?
The fasting blood glucose (sugar) test is the preferred way to diagnose diabetes. It is easy to perform and convenient. After the person has fasted overnight (at least 8 hours), a single sample of blood is drawn and sent to the laboratory for analysis. This can also be done accurately in a doctor’s office using a glucose meter.
Normal fasting blood glucose is between 70 and 100 mg/dl for people who do not have diabetes.
Fasting plasma glucose levels of more than 126 mg/dl on two or more tests on different days indicate diabetes.
A random blood glucose test can also be used to diagnose diabetes. A blood glucose level of 200 mg/dl or higher indicates diabetes.
On occasion, an oral glucose tolerance test may aid in the diagnosis of diabetes or an earlier abnormality that may become diabetes – called impaired glucose tolerance.
What are some complications of diabetes?
Acute complications: dangerously elevated blood sugar (hyperglycemia) or abnormally low blood sugar (hypoglycemia) due to diabetes medications.
Chronic complications: disease of the blood vessels (both small and large) that can damage the feet, eyes (retinopathy – All patients with diabetes should see an ophthalmologist (eye specialist) yearly for a dilated eye examination. Patients with known eye disease, symptoms of blurred vision in one eye, or who have blind spots may need to see their ophthalmologist more frequently), kidneys (nephropathy – Urine testing should be performed yearly. Regular blood pressure checks also are important because control of high blood pressure is essential in slowing kidney disease. Generally, blood pressure should be maintained at less than 130/80 in adults. Persistent leg or feet swelling also may be a symptom of kidney disease and should be reported to your doctor), nerves (neuropathy – Numbness or tingling in your feet should be reported to your doctor at your regular visits. You should check your feet daily for redness, calluses, cracks or breakdown in skin tissue) and heart.
Other long-term may complications include:
- Eye problems including glaucoma and cataracts
- Dental problems
- High blood pressure
- Heart disease
Over time, diabetes can lead to blindness, kidney failure, and nerve damage. These types of damage are the result of damage to small vessels, referred to as a microvascular disease. Diabetes is also an important factor in accelerating the hardening and narrowing of the arteries (atherosclerosis), leading to strokes, coronary heart disease, and other large blood vessel diseases.
Diabetes treatment depends on the type and severity of diabetes.
Type 1 diabetes is treated with insulin, exercise, and a diabetic diet.
Type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control elevated blood sugars, oral medications are used. If oral medications are still insufficient, insulin and other injectable medications are considered.
The goals of managing diabetes are to:
- Keep your blood glucose levels as near to normal as possible by balancing food intake with medication and activity.
- Maintain your blood cholesterol and triglyceride (lipid) levels as near the normal ranges as possible by decreasing the total amount of fat to 30% or less of your total daily calories and by reducing saturated fat and cholesterol.
- Control your blood pressure. (Your blood pressure should not go over 130/80.)
- Decrease or possibly prevent the development of diabetes-related health problems.
You hold the keys to managing your diabetes by:
- Planning what you eat and following a balanced meal plan
- Exercising regularly
- Taking medication, if prescribed, and closely following the guidelines on how and when to take it
- Monitoring your blood glucose and blood pressure levels at home
- Keeping your appointments with your health care providers and having laboratory tests completed as ordered by your doctor.
What you do at home every day affects your blood glucose more than what your doctor can do every few months during your check-ups.