All You Need To Know About Diabetes.

Diabetes

Diabetes is the classic 21st century disease. Known as a medical condition for thousands of years, it has risen in Western countries to almost epidemic proportions in the last 50 years. According to the American Diabetic Association, 7% of the American population, 20.8 million children and adults, currently suffer from various forms of diabetes.

All You Need To Know About Diabetes.

At least one third of this number, or 7.2 million people, are undiagnosed, and unaware of the damage that complications of diabetes can cause.

The term diabetes actually includes several different syndromes, each with different risk factors and causes. As research continues, more sub-types are discovered, and treatments become more specific, with many clinics specialising in diabetic treatment and prevention.

Diabetes Introduction

Diabetes is the classic 21st century disease. Known as a medical condition for thousands of years, it has risen in Western countries to almost epidemic proportions in the last 50 years. According to the American Diabetic Association, 7% of the American population, 20.8 million children and adults, currently suffer from various forms of diabetes. At least one third of this number, or 6.2 million people, are undiagnosed, and unaware of the damage that complications of diabetes can cause.
The term diabetes actually includes several different syndromes, each with different risk factors and causes. As research continues, more sub-types are discovered, and treatments become more specific, with many clinics specialising in diabetic treatment and prevention.

Today the main types of diabetes are classified as Type 1, or juvenile diabetes, Type 2, or adult onset diabetes, and gestational diabetes, which is diabetes which begins in pregnancy. The common factor in all types of diabetes is an uncontrolled rise in blood sugar and an inability to metabolise this sugar into energy usable by cells. However, the reasons for this in Type 1 are completely different to the reasons in Type 2 and gestational diabetes, and the disease acts quite differently.


Type 1 Diabetes

Type 1 diabetes, or juvenile diabetes, usually develops in children and young adults. It is believed to be caused by an immune reaction in which the body destroys cells in the pancreas which produce insulin. Insulin is the hormone responsible for 'telling' cells to absorb and use blood sugar, so when the cells producing it suddenly stop working, blood sugar rises very rapidly. This is what causes most of the symptoms of type 1 diabetes.

Type 1 diabetes is an acute disease, and its symptoms are usually easy to see. Although diabetes can sometimes start in infancy, the classic case history is a child in mid-teens who loses weight, feels weak and thirsty all the time, and passes a lot of urine. Often vision is disturbed, and things may seem blurred or distorted. If treatment is not started, the child may lose consciousness and enter a diabetic coma.

When a doctor suspects type 1 diabetes, he will perform a simple blood test. There are two commonly used blood tests, either of which is acceptable;

Fasting Blood Sugar Level- blood is tested for glucose levels after an overnight fast. Nothing is eaten after 12 at night, and blood is drawn in the morning. Levels over 140mg/dl on two occasions means that the person has diabetes. In type 1 diabetes levels will typically be much higher than normal.

Oral Glucose Tolerance Test- the person being tested fasts for at least 10 hours, and blood is drawn. Then they are given a drink with 75 grams of glucose ( or 100 grams for a pregnant woman). Blood is taken after 30 minutes, 1 hour, two hours and three hours after this. Blood sugar levels rise after drinking the glucose in both healthy people and diabetics, but a level over 200mg/dl after 2 hours means the patient is diabetic.

Type 1 diabetes treatment

Although a diagnosis of type 1 diabetes may seem devastating, treatment options are sophisticated and many people live a full and active life with diabetes. The key to living with type 1 diabetes is education, and many good diabetes education programs exist. Patients are taught to use a glucometer to measure glucose levels, to understand when, how and where to inject insulin, and how to recognise and treat symptoms of hypoglycemia ( low blood sugar) and hyperglycemia (high blood sugar) which can be dangerous. After learning how to treat their type 1 diabetes, even quite young children are encouraged to take responsibility for their treatment. Most respond well and soon get used to dealing with it.

Type 2 Diabetes


Type 2 diabetes is the most common form of diabetes. It is caused by a number of factors, among them excess weight, loss of sensitivity of cell receptors to insulin, and a gradual decline in activity of insulin producing cells. Insulin is the hormone which 'tells ' the cells to absorb blood sugar and use it. In type 2 diabetes, there is a gradual rise in blood sugar, and the body adapts to this gradual rise, so that it seems as though nothing is wrong. It is an insidious disease which can go undetected for many years, and many patients realise only when they have complications that they are suffering from type 2 diabetes.

Type 2 diabetes symptoms

Symptoms of type 2 diabetes are usually hard to pinpoint. The patient may not drink much more than usual, and urine output may seem normal. Excess weight is a good sign that something may be wrong, and since diagnosis is easy, most doctors will check glucose levels in seriously overweight patients routinely. Other type 2 diabetics are diagnosed after their optometrist sees the characteristic signs of blood vessel deterioration which are obvious after a few years, and some will be alerted by reccurrent skin infections or candida.

Type 2 diabetes treatment

Treatment for type 2 diabetes is usually quite effective, and many diabetics, especially those who have the good luck to be diagnosed early, lead full and active lives with minimal complications. It is important to keep blood sugar balanced, as this is the way to avoid complications. Also, type 2 diabetics need to keep cholesterol levels and triglycerides down, since they have an increased risk of heart disease and stroke. Diabetics who smoke are at high risk of complications in peripheral blood vessels and heart disease.

The best way to reduce blood sugar levels and to reduce risk of heart disease and stroke is to exercise regularly, and one of the best ways is to join a diabetes walking group, many of which exist throughout America. The American Diabetic Association funds and participates in many of these groups. It is also important to become educated in diabetes treatment and to take an active part in treatment. Oral medications used to control type 2 diabetes are developing at a rapid pace, and it is a good idea to stay abreast of new types of treatment. Weight loss is another area where the patient can actively influence treatment, and learning how to eat a balanced and healthy diet is part of the life style changes which will contribute to feeling well with type 2 diabetes.


Diabetes Symptoms


Diabetes Symptoms

Diabetes symptoms commonly experienced are more or less the same for all types of diabetes. The difference is in the severity, and in the amount of time that symptoms are present before treatment is sought. In Type 1 diabetes, diabetes symptoms will usually be present only for a few weeks at most before the disease becomes severe enough to force the sufferer to seek treatment.
On the other hand, Type 2 diabetics will often have diabetes symptoms for years without realising that anything is really wrong, and will only be diagnosed when complications are noticed. For this reason a list of common complications is included here, as they can be used almost as additional diabetes symptoms, especially for older people.

Symptoms of diabetes

  • Excessive thirst- this means feeling thirsty even after drinking a lot, or needing to get up at night to drink. In type 1 this becomes so severe that the diabetic may even dream about drinking, but in type 2 may be quite hard to pinpoint. It is caused by the body's attempts to dilute the excessive amount of sugar present in the blood.
  • Excessive urination- this again is much more obvious in type 1. It is the natural consequence of drinking enough to dilute blood sugar levels.
  • Hunger- this is present in both types, and is a result of the fact that cells are starved of energy, and demand food. However much the diabetic eats, no energy gets to the cells, and blood sugar rises even more.
  • Losing weight- more common in type 1, because the body turns to stored fat to continue metabolism. In type 2 usually some sugar is metabolised, and the body manages to lay down fat.
  • Fatigue- caused by the need to metabolise fat reserves and the lack of energy.
  • Bad mood- a psychological result of hunger and lack of energy.
  • Blurred vision- caused in type 1 by high blood sugar levels affecting the optic nerve, and in type 2 by long term damage to blood vessels. Often the first diabetes symptom diagnosed by a professional.

Complications of diabetes

These complictions occur after several years, and although they are not diabetes symptoms and can occur in other diseases, they are frequently the first sign which alert type 2 diabetics to their illness.
  • Cuts heal slowly and often get infected. Abcesses and gum diseases, frequent thrush in women, bladder infections. Caused by the large amounts of sugar in bodily fluids which encourages infection, and by deterioration in blood supply to the extremities.
  • Tingling or numbness in fingers and toes. Caused by nerve damage, often painful and unfortunately irreversible.
  • Foot complications- because nerve damage can reduce sensation in the feet, often diabetics don't realise that they have an ulcer or infection. Skin is drier than normal, and this aggravates the condition.
  • Styes, boils and carbuncles of various kinds are all more common in diabetics.
  • Glaucoma, cataract and diabetic retinopathy of different types can all be diagnosed by an optometrist who will often alert the patient to the possibility of diabetes.


Diabetes Treatment

Diabetes treatment has come a long way since the discovery and purification of the hormone called insulin in 1921. It seems incredible to think that until that discovery the overwhelming majority of type 1 diabetics died fairly rapidly. Nowadays a simple injection is enough to bring down blood sugar levels and save lives.
Insulin, the hormone responsible for mediating cell uptake of sugar, is injected subcutaneously ( under the skin) using a fine needle. Type 1 diabetics, and some type 2 diabetics whose diabetes is severe enough to demand treatment in this way, learn to monitor blood sugar levels with a simple machine called a glucometer. After becoming proficient in keeping the level of blood sugar stable, most diabetics treat themselves with very little need for guidance on a daily basis.

Type 1 diabetes treatment

Type 1 diabetes treatment becomes more sophisticated nearly every day, with human bio-engineered insulin available in short acting, medium acting and long acting varieties, as well as tailor made mixtures providing good blood sugar control for every type of life-style. The insulin pump, once used as diabetes treatment for pregnant women who needed constant blood sugar levels in order to avoid complications, has become popular with many type 1 diabetics, and many sophisticated models exist. Research into curing diabetes by transplanting insulin producing cells to the pancreas is beginning to look promising, and the outlook for type 1 diabetes treatment in general is bright.

Type 2 diabetes treatment

Type 2 diabetes treatment too has been transformed by research, and most type 2 diabetics today can control their disease well enough to delay complications for years. The emphasis in type 2 diabetes treatment is on oral drugs, and there are many different approaches to blood sugar control. However, because type 2 diabetes is usually caused by insensitivity to insulin and excess weight, type 2 diabetes treatment involves much more than just drugs.
The type 2 diabetic, or ideally pre-diabetic, if diagnosed before full diabetes starts, will recieve most benefit from a program which includes medically supervised exercise, weight loss, diet to lower cholesterol and triglycerides, and stopping smoking, as well as blood sugar monitoring and control.

Diabetes treatment goals

The American Diabetes Association has set basic diabetes treatment goals which are;
  • Maintain a near normal level of blood glucose. ( Normal levels are between  4-8 mmol/l, or 60-100mg/dl ) . This can be acheived by balancing diet, exercise and medication.
  • Achieve and maintain optimal blood lipid levels. ( Normal levels are; Total lipids- < 200mg/dl, LDL cholesterol <100mg/dl, HDL cholesterol > 60mg/dl, triglycerides <150mg/dl.)  
  • Achieve and maintain optimal weight.
  • Prevent or treat complications of diabetes.
Because diabetes is a chronic disease, one of the biggest obstacles to successful diabetes treatment is psychological. Although treatment options and diabetes clinics are widely available and usually inexpensive or covered by Medicare, the fact is that the majority of diabetics do not meet long term treatment goals. The difficulty of maintaining optimum weight in a society which encourages excess is a huge challenge to most diabetics. In recognition of this fact the American Diabetes Association organises social events and community programs which attempt to improve treatment compliance and give psychological support for life style changes.

Styes, boils and carbuncles

Gestational Diabetes

Gestational diabetes is diabetes which starts during pregnancy, in women who have not previously had high blood sugar. it affects about 4% of pregnant women, and is a significant health risk which needs to be monitored and treated properly.

Gestational diabetes is caused by hormones produced by the placenta. These hormones stop insulin from working to lower blood sugar, and as a result, blood sugar levels rise. The amount of insulin needed by a pregnant woman may be three times as much as normal, and although the cells producing insulin work as hard as they can, eventually they are not able to keep up with demand. It is believed that some women who develop gestational diabetes were suffering from undiagnosed pre-diabetes before pregnancy, and these women sometimes need to continue treatment for diabetes after pregnancy. However, the majority of women regain normal blood sugar levels after birth.

There is a high probability of having gestational diabetes in a subsequent pregnancy after it has occurred once, and women who are at risk should start blood sugar monitoring as early as possible.

The complications of gestational diabetes affect both mother and baby, and before the risks were understood, it was a major cause of death in labour. The problem is that while insulin cannot cross the placenta, sugar can. This means that if diabetes is not treated, the developing baby recieves too much sugar. The baby's pancreas starts to produce large amounts of insulin, and the excess sugar is converted to fat. The baby may become very fat, a condition known as macrosomia. At birth the baby's shoulders may be too large to pass down the birth canal, and a cesarian section is neccesary. After birth, the large amount of insulin produced by the baby's pancreas can cause hypoglycemia ( low blood sugar ) and if untreated this can lead to coma and death.

For these reasons, it is extremely important to keep sugar levels balanced during pregnancy. Methods of treatment are a dietician planned diet, moderate exercise, and for some women, insulin therapy. The good news is that treatment is usually effective in reducing complications, and women who follow their doctors instructions will usually give birth to healthy babies.

Women who have had gestational diabetes are at risk of developing type 2 diabetes years later, even if blood sugar levels are normal after birth. For this reason, doctors recommend this group of women to lose excess weight, eat a healthy diet and take regular exercise in order to reduce risk factors.



Diabetes Mellitus

Diabetes mellitus means, literally, 'the sweet siphon'. Recognised since early Greek times, diabetes was classified together with other conditions which caused excessive urination, since this was all that was known about it. Aretaeus of Cappadocia, a Greek physician, was the first to call the condition diabetes, but mellitus, from the Greek word for honey, was added only in 1675 by an English doctor by the name of Thomas Willis.

Diabetes mellitus was known to cause sweet urine by doctors in antiquity, and methods of testing patients urine including tasting it were used. However, the sweet urine of diabetes mellitus was just a curiosity, since no treatment existed, and nothing was really known about the disease.

Research into the causes of diabetes mellitus began in earnest at around the beginning of the last century, and after German researchers discovered that the pancreas seemed to produce a substance that balanced blood sugar, the way was clear for the discovery of insulin. Two researchers working at the University of Toronto, Banting and Best, managed to isolate the hormone from pancreatic tissue in 1921. During the next few years insulin production became more sophisticated and spread to most of the civilised world, saving many lives and reducing suffering for many. Gradually insulin therapy developed and different forms of insulin were created, some short acting, some medium acting and some long acting. This meant that diabetics could finally live relatively normal lives. Today it seems unbelievable that diabetes mellitus type 1 was once an acute disease which ended in death for children and young adults.

Of course, the history of diabetes mellitus treatment was only just beginning. When Banting and Best revolutionised treatment with insulin, it was still unknown that diabetes mellitus was actually three different diseases. In the years following their work, the field of diabetes research became popular, and it was only a matter of time before type 1, type 2 and gestational diabetes were discovered. As drugs were found to treat type 2 more effectively, more and more people benefitted. Today treatment methods for diabetes mellitus are cheap, widely available and effective, and research regularly yields better drugs. Although a definitive cure still eludes us, type 1, 2 and gestational diabetes mellitus can be controlled to the point that diabetes patients who actively participate in treatment can have the same risk of complications as non-diabetics.
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All You Need To Know About Diabetes. All You Need To Know About Diabetes. Reviewed by Divyansh mali on December 03, 2019 Rating: 5

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