Diabetes

DIABETES

What is Diabetes?

Diabetes is a medical condition that affects how your body uses blood glucose or blood sugar. It occurs when your blood glucose or blood sugar is too high.

Glucose is an important source of energy for the cells in the body and it is the main source of fuel for the brain. The two major sources of glucose for your body are from the food you eat and your liver.

Insulin is a hormone made by the pancreas that helps glucose from food get into your cells to be used for energy. With the help of insulin, this glucose is absorbed from the intestine to the blood and into the cells. Glucose is also stored and made in the liver which is broken down and released into the blood when you fast or do not eat for a while.

Sometimes your body doesn’t make enough or any insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells. Any of these medical conditions is known as diabetes.

Types of Diabetes

There are many types of diabetes depending on the cause, but all types increase the blood sugar levels. Excess sugar can affect organs in the body and can also result in heart attacks and stroke.

The types of diabetes are as below:

Prediabetes:  Prediabetes or borderline diabetes is when blood sugar is between 100 to 125 mg/dL. Here the blood glucose is higher than usual, but not so high to diagnose it as diabetes. Prediabetes doesn't usually have any signs or symptoms.

Type 1 diabetes:  Here, your body fails to produce insulin. Your immune system attacks and destroys the cells in your pancreas that make insulin. As such patients do not have insulin production, they must take Insulin throughout their life. It’s usually diagnosed in children and young adults but can develop at any age.

Type 2 diabetes:  This is the most common type of diabetes and it impairs the way the body uses insulin. Here the cells in the body do not respond to insulin effectively even after the body produces it. It usually occurs in middle-aged and older people.

Gestational diabetes:  Diabetes that affects pregnant woman as the body becomes less sensitive to insulin is gestational diabetes. If you have gestational diabetes you are at higher risk of developing Type 2 diabetes later on in life. Most pregnant women may never have signs of gestational diabetes.


Causes of Diabetes

Type 1 diabetes:  The exact cause is still unknown, but the immune system attacks and destroys the cells in the pancreas that produce insulin. This results in less or no insulin production. Glucose is not transported to the cells and builds up in the blood in the absence of insulin. This type of diabetes is believed to be caused by both genetic and environmental factors.

Type 2 diabetes:  Here your cells become resistant to the action of insulin and the pancreas is unable to produce enough insulin which results in sugar build up in the blood. Obesity, unhygienic food and bad lifestyle are believed to be the primary causes of this type of diabetes.

Gestational diabetes:  This diabetes is the result of hormonal changes during pregnancy. The hormones produced by the placenta during pregnancy makes the cells more resistant to insulin. This is usually compensated by pancreas producing more insulin, but if it does not then it results in gestational diabetes.


Symptoms of Diabetes

The symptoms vary depending on the level of blood sugar. Type 1 diabetes symptoms may appear relatively suddenly. Prediabetes and type 2 diabetes usually do not cause any symptoms initially.

Common symptoms:

  Increased thirst

  Increased hunger

  Unintentional weight loss

  Frequent urination

  Blurred vision

  Slow healing of wounds

  Weakness and tiredness

  Irritability


Symptoms in women:

  Yeast infection

  Urinary tract infections

  Dry and itchy skin


Symptoms in men:

  Muscle weakness

  Reduced sex drive

  Erectile dysfunction


Type 1 diabetes symptoms:

Symptoms may appear relatively suddenly may be over a few weeks or months and they are:

  Increased thirst

  Increased hunger

  Frequent urination

  Blurred vision

  Irritability and other mood changes


Type 2 diabetes symptoms:

Symptoms may appear relatively slowly. Sometimes you can live with type 2 diabetes for years and not aware about it. When symptoms are present they are:

  Increased thirst

  Increased hunger

  Frequent urination

  Unintended weight loss

  Blurred vision

  Slow-healing sores

  Weakness and tiredness


Gestational diabetes symptoms:

Most women with gestational diabetes don’t have any symptoms. The condition is often detected during a routine blood sugar test or oral glucose tolerance test that is usually performed between the 24th and 28th weeks of gestation.



Risk factors of Diabetes

Research shows that some behaviors or conditions may increase a person’s chances of having a diabetes. These are called Risk Factors.

Risk factors for type 1 diabetes include:

  Having a family history of Type 1 diabetes

  Injury to the pancreas by infection, tumor, surgery or accident

  Presence of autoantibodies that mistakenly attack your own body’s tissues or organs


Risk factors for prediabetes and type 2 diabetes include:

  Having a family history of Type 2 diabetes.

  Being an overweight

  Having a high cholesterol or high blood pressure or high triglycerides

  Haveing a physically inactive lifestyle

  Increasing age like 45 years and above

  Pregnancy

  Hypertension

  Polycystic ovary syndrome (PCOS)

  Being African American, Hispanic or Latino American, Asian American


Risk factors for gestational diabetes include:

Symptoms may appear relatively slowly. Sometimes you can live with type 2 diabetes for years and not aware about it. When symptoms are present they are:

  Having a family history of Type 1 diabetes

  Being overweight before your pregnancy

  Being over 25 years of age

  Had gestational diabetes during a past pregnancy

  Have given birth to a baby weighing more than 9 pounds

  Polycystic ovary syndrome (PCOS)


Complications of Diabetes

If your blood glucose level remains high over a long period of time, your body’s tissues and organs can be seriously damaged. Some complications can be life-threatening over time.


These complications include:

Heart:   It increases the risk of heart problems like angina, high cholesterol, heart attack, stroke and atherosclerosis.

Neuropathy:  It damages the tiny blood vessels that supply the nerves in the limbs, which results in tingling, numbness and pain at the tips of the toes or fingers and then speard.

Nephropathy:  The kidney function is affected when excess sugar damages the tiny blood vessel in the kidneys. It can also lead to kidney failure or dialysis or transplant.

Retinopathy:  The blood vessels of the retina get damaged, resulting in blurred vision, and blindness. It can also cause cataracts and glaucoma.

Dental disease:  Diabetes can reduce the blood supply to the gums making dental problems, such as gum and bone infections, more likely. High blood sugar may also cause dry mouth and exacerbate gum disease.

Foot infections:  Poor blood supply and nerve damage results in sores and blisters to form on the toes. If left untreated, it can get infected and cause gangrene.

Skin infections:  The skin susceptible to many fungal and bacterial infections.

Hearing problems:  It increases the risk of hearing problems.

Memory problems:  It increases the risk of dementia or Alzheimer's disease.

Mental problems:  It increases the risk of depression.

Erectile dysfunction:  It increases the risk of erectile dysfunction.


Complications of Gestational Diabetes

Gestational diabetes can affect both the mother and her baby.


Complications in the mother are:

Preeclampsia:  It is a life-threatening condition, which causes high blood pressure, protein in the urine, and swelling in the legs and feet.

Risk of gestational diabetes again:  It increases the risk of you having gestational diabetes in the future pregnancy and risk of diabetes later in life.


Complications in the baby are:

Macrosomia:  Excess sugar in the mother’s blood can reach the baby through the placenta, which results in the production of excess insulin by the baby's pancreas. This results in the baby growing too big, which requires birth by cesarian.

Hypoglycemia:  The blood sugar level drops in some babies shortly after birth due to the high production of insulin, which requires prompt treatment.

Obesity:  Babies are at higher risk of being overweight later in life if the mother had gestational diabetes.

Death:  Untreated gestational diabetescan result in fetal death.



How is diabetes diagnosed?

Diabetes is diagnosed and managed by checking your glucose level in a blood test. Below are tests that can measure your blood glucose level:


  Fasting blood sugar test: Blood is collected and glucose level is checked after fasting overnight (an eight hours fast). A fasting blood sugar level between 100 and 125 mg/dL is considered prediabetes, and if it is 126 mg/dL or higher, it is diabetes.

  Random blood sugar test: Blood is collected and glucose level is checked at any time. If the random blood sugar level is 200 mg/dL or higher, it is diabetes.

  Glycated hemoglobin test (HbA1c) test: This indicates the average blood sugar level for the past three months, by measuring the percentage of blood sugar attached to hemoglobin.

  Oral glucose tolerance test: After the fasting blood sugar level is measured, you are supposed to drink a sugary liquid, and the blood sugar levels are checked for the next two hours. Blood sugar level less than 140 mg/dL is normal, and more than 200 mg/dL indicates diabetes.


Type of Test
Normal (mg/dL)
Prediabetes (mg/dL)
Diabetes (mg/dL)
Fasting blood sugar test
Less than 100
100 - 125
126 or higher
Random blood sugar test
Less than 140
140 - 199
200 or higher
HbA1C test
Less than 5.7%
5.7% - 6.4%
6.5% or higher
Oral glucose tolerance
Less than 140
140 - 199
200 or higher


Treatment options for diabetes

Treatments for diabetes depend on your type of diabetes and your existing health conditions. Doctors treat diabetes with different medications, diet and exercises. Some of these drugs are taken as tablets or capules while others are taken as injections.


Insulin:

It is used to control blood sugar levels in type 1 diabetes and even type 2 diabetes that is not controlled by medicines.


Below are most commonly used types of insulin:

Rapid-acting insulin: starts to work within 15 minutes and its effects last for 3 to 4 hours.

  Apidra

  Humalog

  Insulin aspart

  Insulin lispro

  NovoLog


Short-acting insulin: starts to work within 30 minutes and lasts 6 to 8 hours.

  Humulin R


Intermediate-acting insulin: starts to work within 1 to 2 hours and lasts 12 to 18 hours.

  Humulin N

  Novolin N


Long-acting insulin: starts to work a few hours after injection and lasts 24 hours or longer.

  Basaglar

  Lantus

  Levemir

  Toujeo

  Tresiba


Medications:

It is used to control blood sugar levels in type 2 diabetes.

Below are diabetes medication drug classes:

Alpha-glucosidase inhibitors

  Acarbose

  Miglitol

  Precose


Biguanides

  Metformin


Bile acid sequestrants

  Cholestyramine

  Colesevelam

  Colestid

  Colestipol

  Questran

  Welchol


DPP-4 inhibitors

  Januvia

  Nesina

  Onglyza

  Tradjenta


Dopamine agonist

  Cycloset


GLP-1 (glucagon-like peptide-1)

  Byetta

  Rybelsus

  Trulicity


Meglitinides

  Nateglinide

  Repaglinide


SGLT2 inhibitors

  Farxiga

  Invokana

  Jardiance


Sulfonylureas

  Amaryl

  Glimepiride

  Glipizide

  Glucotrol

  Glyburide


Thiazolidinedione

  Actos

  Pioglitazone


Diet:

Take:

  Fiber rich foods

  Fruits and vegetables

  Nuts

  Whole grains

Reduce:

  Sugar

Avoid (or at least reduce):

  Fatty foods

  Tea, Coffee

  Energy drinks, Cold drinks

  Smoking and Alcohol


Lifestyle:

  Lose body weight

  Take early and enough sleep

  Do Meditation


Exercise:

  Do Walking or Jogging or Running

  Playing various sports


In all the above, you will notice that taking care of your health and diabetes is all about medications and lifestyles. Type 1 diabetes is out of your control. Where type 2 diabetes can be prevented with better food choices, increased activity, and weight loss.

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